In India, tuberculosis (TB) is a public health challenge that mainly affects vulnerable communities. Earlier this year, the eastern state of Chhattisgarh declared 4,106 gram panchayats (basic governing institutions in Indian villages) TB-free. The TB-Free Panchayat Program achieved this milestone by combining government action and community involvement.

Other programs, such as the Nikshay-Niramay Chhattisgarh 100-Day Campaign, intensified TB detection and treatment through door-to-door screenings and immediate diagnostic testing. TB affects the most vulnerable groups and has severe socioeconomic consequences for individuals, families and communities. For this reason, eliminating TB through community programs is a turning point for India.

The Problem

Between 2015 and 2023, India experienced a significant decline of 17.7% in TB incidence. However, 2.7 million cases were still registered in 2023. Also, the disease costs India an estimated $23 billion annually and the global TB response is underfunded.

For example, only 20% of the $5 billion research funding target was met in 2022. Most importantly, socioeconomic and health care factors affect diagnosis and treatment in the country, with often uneven progress across different areas. The main issues of national TB control are:

• programmatic data quality
• testing variation
• gaps in TB preventive treatment (TPT)
• variability in district-level performance

Consequently, vulnerable, rural, tribal and remote populations face the most significant access barriers, as distance from health facilities is a major reason for not seeking care. Although the public sector covers vulnerable groups financially, HR shortages, drug stockouts and poor diagnostics limit the services provided.

Especially among the needy, lack of trust and poor facility experience contribute to diagnostic delays and missed cases. As an example, rural districts like Niwari have poor awareness of TB and its stigma leads to delayed care. Also, for vulnerable groups, the economic burden of TB is often devastating since the spread of the disease increases unemployment.

A study based in Assam, Maharashtra, Tamil Nadu and West Bengal found that more than 50% of patients incurred catastrophic costs before diagnosis due to a nine-week delay in diagnosis.

TB in Chhattisgarh

Chhattisgarh, where about 80% of the population lives in rural areas, carries a heavy burden of communicable diseases. Tribal and remote communities face major health care barriers, including long travel distances, poor transportation, a shortage of qualified health care providers and limited diagnostic facilities. In addition, many TB cases in the state are diagnosed at secondary and tertiary health facilities, which reduces the effectiveness of household contact investigations.

A study conducted in urban slum areas of Durg district revealed that the population is particularly vulnerable due to high-density living, low socioeconomic status and limited access to structured health care.

The Solution

Chhattisgarh’s progress toward TB-free panchayats emerged from a model that placed communities, local governments and frontline workers at the center of the response. The TB-Free Panchayat Program built its strength on systematic door-to-door surveys, household contact screening and rapid referral. The program was led primarily by ASHAs (village health volunteers) who coordinated closely with gram sabhas (village-level legislative bodies) and primary health center teams.

These teams were trained to dispel stigma, identify presumptive cases and support adherence. Gram panchayats were encouraged to integrate TB activities into their regular development plans, including sputum transport and social support for vulnerable families. Special gram sabhas in tribal districts brought together youth groups, traditional leaders and TB champions.

These groups worked together to screen high-risk households. This joint effort helped communities see TB as a shared problem rather than an external medical issue. This approach produced measurable results. In Rajasthan, similar assessments showed that active case finding and community awareness reached some of the highest scores in programme evaluation, demonstrating that village-led structures can sustain screening and follow-up at scale.

Local voices in Chhattisgarh echoed this shift. Health Minister Shyam Bihari Jasiwal noted that success was possible only when society participated alongside the government, underscoring the sense of ownership communities have developed in their path toward TB-free status.

Looking Forward

Chhattisgarh’s progress demonstrates that TB can be reduced when communities take the lead in the fight against the disease. As panchayats take responsibility for screening, awareness and support, they strengthen trust and make early care possible for the people who need it most. The state’s experience proves that local leadership and consistent engagement can overcome long-standing barriers in rural and tribal areas.

With continued investment in frontline workers and community participation, Chhattisgarh can sustain these gains and serve as a guide for other states working toward a TB-free future.

– Angela D’Avino

Angela D’Avino is based in Preston, UK and focuses on Good News, Global Health for The Borgen Project.

Photo: Pixabay