Accelerating the progress toward ‘End TB’ in India

TIFA’s fixed price mechanism has proved to be a ground-breaking innovation in the national fight to eliminate tuberculosis by 2025,” says Dr. Raghuram Rao, Assistant Director General (TB), Central TB Division, Ministry of Health and Family Welfare.

In India, Tuberculosis Implementation Framework Agreement (TIFA) works closely with USAID and the National TB Elimination Program (NTEP), stewarded by the Central TB Division (CTD) of the Ministry of Health and Family Welfare, to award grants and other contracts to government entities, international and local NGOs, and private sector partners. Awards enable partners to implement catalytic activities, helping the NTEP to test, critically assess, prioritize and/or scale new interventions needed to fill program gaps and accelerate progress in its 2025 TB elimination strategy.

Flexible design: Meeting the needs of NTEP

TIFA, with its ability to respond quickly to NTEP’s priorities through fixed amount awards, has become a key NTEP partner. TIFA also identified the need for alternate funding mechanisms and has developed contracts and consultancies to meet country needs. While TIFA was originally designed to support national TB programs directly, in India it works closely with the CTD to grant awards to implementing partners. To date, TIFA has awarded 18 grants and contracts to 12 implementing partners of which seven are local development partners and public health research organizations.

TIFA awards enable partners to implement catalytic activities

Within one month of its initiation in India, TIFA awarded its first grant for a needs assessment to deploy technical support units in five states to accelerate progress to eliminate TB. TIFA also worked with CTD to identify priority areas; CTD requested resources to demonstrate differentiated TB care models and test innovations in pediatric TB care service delivery.

India has the largest burden of TB infections in the world. To address this, India committed to the UN-SDG target to reduce TB deaths by 90% by 2030. However, the COVID-19 pandemic temporarily derailed the momentum of India’s End TB strategy.

The findings of the latest National TB Prevalence Survey of India (2019–2021) showed much higher prevalence rates than expected. In addition, the survey found that the majority of patients (64%) do not seek treatment because they are not aware of TB symptoms. These findings called for an urgent re-alignment of the strategy.

After a competitive process, TIFA awarded three grants to demonstrate differentiated TB care models, which included sub-district health and wellness centers and district health facilities. The TB triage app for escalating high-risk cases and the resource package for training health providers on managing those cases provide critical inputs to the program. Similarly, two awards are supporting the design and pilot of activities to strengthen pediatric TB sample collection at block level. These grants will document the facilitators and barriers to assist the national program during scale-up.

TIFA grants are also supporting the evaluation of active case finding for detection and direct benefit transfer under the Ni-kshay Poshan Yojana to provide financial support for nutrition projects. This will generate evidence about the effect of these interventions and inform course correction, if required. A TIFA award is also supporting a study on robust estimations of TB related deaths in India, which will match survey results with the national TB portal reports to determine urgent reporting gaps flagged by the NTEP.

In addition to these grants, TIFA has facilitated community engagement events including the Step Up to End TB Summit held in March 2022. When NTEP highlighted the importance of using social media to engage a larger audience, TIFA supported the recruitment of a communications agency. This enabled the national program to reach people of all ages and risk categories with key messages.

Looking Ahead

TIFA has responded to NTEP needs swiftly and supported it to strengthen End TB by 2025 goal efforts. In the critical years building up to the target of 2025, TIFA awards are catalyzing interventions to accelerate the TB program.

Going forward, TIFA will continue its close partnership with the NTEP by supporting the government’s “Community Support to People with TB – Pradhan Mantri TB Mukt Bharat Abhiyaan.” This initiative aims to increase community involvement and provide critical nutrition support for TB patients to improve treatment outcomes. TIFA will also fund TB interventions for key populations, including the urban poor and people who are incarcerated.