Financing India’s Fight to End Tuberculosis

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Tuberculosis (TB) is the leading cause of death from a single infectious agent, even though it is preventable and curable. India has the highest TB burden globally, accounting for 26 percent of the new cases in 2023. Despite an 18 percent decline in incidence between 2015 and 2023, the shortage of resources threatens to erode these gains. However, the problem extends beyond the financial allocations to how the resources are allocated and utilised. As India works towards ending the TB epidemic by 2030, in line with the United Nations Sustainable Development Goals (UN-SDGs) target 3.3, addressing the funding gaps is key.

The TB Financing Architecture in India

India’s National Tuberculosis Elimination Programme (NTEP) is the flagship government TB programme. It is centrally sponsored, under the National Health Mission (NHM), guided by the National Strategic Plan for Tuberculosis 2017–2025 (NSP 2017–25). The NSP 2017–25 estimated a requirement of INR 12,327 crore (approximately US$1.334 billion) over the eight-year period to tackle TB.

Tuberculosis (TB) is the leading cause of death from a single infectious agent, even though it is preventable and curable.

The central government provides funds, and the state governments contribute to them. As depicted in Table 1, domestic funding for TB has increased substantially over recent years. The domestic financing is supported by international funding as well.

Table 1: Financial Performance of the NTEP (in INR Crore)

Source: NTEP (2024)

The Global Fund is a significant international funder for both government and nongovernment organisations in India. For TB, the Global Fund invested US$280 million in India for 2023–2025. Of the total Global Fund allocation to India, 60 percent is made under a Payments for Results model, where funds are disbursed on the achievement of specified results. Additionally, the Ministry of Health and Family Welfare (MoHFW) took a US$400 million loan from the World Bank to support priority outcomes of the NSP 2017-25, which accounts for 30 percent of the total programme cost. As of 2023, approximately 80 percent of the loans had been disbursed under the programme.

A common and flexible fiscal pool (flexipool) has been designed for each programmatic component under the NHM, combining various financial resources, including external aid. The NTEP is funded under the Flexible Pool for Communicable Diseases. The release of funds to the State Health Societies (SHSs) is conditional on utilisation from previous years. Similarly, the SHSs release funds to the District Health Societies (DHSs). The DHSs disburse funds for activities aligned with programmatic objectives and local needs. However, due to delays in transfers, the expenditure is lower than the approved budgets, with funds remaining underutilised, as evident in Table 1.

Only 1 percent of the budget is allocated to TB Preventive Treatment (TPT), despite 6 million households being eligible for it.

Gaps in Financing

Despite the breadth of financing sources, several mismatches undermine impact. A Right To Information (RTI) response from 2025 (filed by IndiaSpend) indicates that the majority of the expenditure on procuring diagnostics and drugs was made in recent years, barring a decline in expenditure during COVID-19, with significant underfunding in previous years (Figures 1 and 2). Furthermore, only 1 percent of the budget is allocated to TB Preventive Treatment (TPT), despite 6 million households being eligible for it. This is important because a latent TB infection may reactivate at any time. Meanwhile, the infected individuals with no apparent symptoms may unknowingly also transmit the disease. Despite TPT being a cornerstone of the World Health Organization’s (WHO) End TB Strategy, it remains neglected in India.

Figure 1: Expenditure on Drugs under TB Programmes

Source: RTI Response (IndiaSpend, 2025)

Figure 2: Expenditure on Diagnostics under TB Programmes

Source: RTI Response (IndiaSpend, 2025)

Additionally, a core component of the programme is to ensure that individuals do not experience significant out-of-pocket expenditure (OOPE). For this, free diagnostics and care are provided under the NTEP. Schemes such as the Nikshay Poshan Yojana transfer INR 1,000 per month to patients’ bank accounts. As of 2024, over 3,202 crore were disbursed among 1.13 crore beneficiaries. However, a 2024 sample study found that 45 percent of the persons with TB (PwTB) continue to incur catastrophic costs, following a pro-poor distribution. Those notified from the private sector were more likely to experience catastrophic costs, even though NTEP provides subsidies for diagnosis and treatment, alongside financial support. It was also found that two-thirds of the total costs were attributed to indirect costs. Compounded by the loss in productivity, the economic challenges faced by PwTB are exacerbated, further impacting TB outcomes.

A 2024 sample study found that 45 percent of the persons with TB (PwTB) continue to incur catastrophic costs, following a pro-poor distribution.

Besides the funding gaps, organisations such as the Tata Trust, through the India Health Fund, Tuberculosis Association of India and International Union Against Tuberculosis and Lung Diseases, among several others, are funding activities to address TB efforts. The government has also created institutional pathways to mobilise corporate resources, such as the Corporate TB Pledge, the Ni-Kshay Mitra Donor programme, and guidance for public-private partnerships. However, the full potential of corporate engagements is yet to be realised. Cumulatively, these financing gaps affect India’s ability to end the TB epidemic.

External Support & Partnerships 

Funding for TB has been declining globally, including in India, as depicted in Figure 3. The withdrawal of the United States Agency for International Development (USAID) in 2024-25 has led to inadequate funding for several TB programmes. In 2025, the WHO warned that ongoing aid cuts threaten the progress made so far in combating TB. A PLOS study modelled the potential impact of the withdrawal of funding from the US. According to this study, in 2023, the total global funding for TB stood at US$5.7 billion, of which 21 percent came from external sources. In 2024, USAID committed US$406 million, while the Global Fund committed US$800 million, of which approximately US$267 million came from the US. If funding gaps persist, the estimates suggest that over 2 million lives may be at risk within six years. For India, particularly, a report by the Stop TB Partnership found that the halt in funding from the US, particularly through USAID, will impact programmatic efforts related to screening and active-case finding, community-led activities, monitoring and operational research, and technical assistance.

Figure 3: Funding available for TB prevention, diagnostic and treatment services in India

Source: WHO (2024)

Additionally, over half of the funding for vaccine research comes from a few large philanthropic organisations. In 2023, the Bill and Melinda Gates Foundation and the US National Institute of Health alone contributed around 53 percent of the total TB research and development (R&D) funding. The lack of diversity of funding sources threatens the availability of sustainable investments in TB. Globally, the total funding for TB R&D is also receiving only a share of the targets across drugs (21 percent), vaccines (18 percent), diagnostics (17 percent), and basic science (20 percent).

In 2025, the WHO warned that ongoing aid cuts threaten the progress made so far in combating TB.

Nevertheless, there is global recognition to ensure increased funding for TB. In 2023, at the UN High-Level Meeting on TB, world leaders committed to raising US$22 billion by 2027. At the XV BRICS (Brazil, Russia, India, China, and South Africa) Health Ministers’ Meeting in 2025, the nations also reaffirmed their commitment to strengthening sustainable financing for TB by mobilising institutions and mechanisms, including multilateral organisations and the private sector. 

Way Forward

According to a 2025 financial gap analysis by the MoHFW, an additional INR 10,686 crore of funding is required to improve programme outcomes. Prioritising funding for TB is essential due to the high economic returns on it. Estimates suggest that investments in TB control yield a return of US$33 for every dollar spent. According to the Stop TB Partnership, eliminating TB could generate an economic return on investment of US$1.2 trillion globally.

Although India has significantly increased its domestic financing, it is far from the amount required to truly end the TB epidemic. Additionally, given the current climate of declining international funding, efforts need to be made to mobilise additional resources to prevent hampering the progress made so far. The World Bank recommends earmarking and health taxes on behaviours that affect population health to manage disease burden and fiscal pressure on health systems.

To move from donor dependence to self-reliance, India must develop a sustainable financing architecture, mobilising additional resources and closing funding gaps to achieve the UN-SDG target by 2030.

Mobilising additional resources through corporate engagements, such as corporate social responsibility, and innovating financing mechanisms, diversifying funding sources, and investing in underfunded areas—including TPT and R&D—will help India achieve its goals. Strengthening collaborations with the private health sector, where about 65 percent of the patients under NTEP first receive care, is necessary to reduce the OOPE for patients. To move from donor dependence to self-reliance, India must develop a sustainable financing architecture, mobilising additional resources and closing funding gaps to achieve the UN-SDG target by 2030.

Nimisha Chadha is a Research Assistant at the Centre for New Economic Diplomacy, Observer Research Foundation.

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