New Delhi, June 27, 2019 – The World Bank and the Government of India today signed a loan agreement of $400 million for the Program Towards Elimination of Tuberculosis. The program aims to improve the coverage and quality of TB control interventions in nine states. TB remains a public health crisis that kills an estimated half a million people in India every year.
The program builds on a partnership between the Government of India and the World Bank that has spanned more than 20 years. World Bank support has contributed to scaling up of Directly Observed Treatment and services to poor and high-risk groups, including tribal households, HIV patients, and children; universal access to diagnostics and quality TB care; and initiation and scale-up of multi-drug resistant TB services. World Bank supported programs have helped treat more than 20 million people since 1998 and averted 3.5 million deaths.
Results areas under the program include rolling out TB patient management and support interventions; strengthening diagnostics and management of drug-resistant TB (DR-TB); and strengthening institutional capacity and information systems. These results areas represent the newest and most innovative aspects of India’s National Strategic Plan and are of national and global significance.
“India’s Tuberculosis Control Program has substantive national and global public health and economic development implications,” said Sameer Kumar Khare, Additional Secretary, Department of Economic Affairs, Ministry of Finance. “The Government of India’s National Strategic Plan is a transformative program and World Bank support through the Program for Elimination of Tuberculosis will bring India closer to achieving the target of eliminating TB by 2025.”
The Loan Agreement was signed by Sameer Kumar Khare, Additional Secretary, Department of Economic Affairs, Ministry of Finance, on behalf of the Government of India; and by Shanker Lal, Acting Country Director, on behalf of the World Bank.
“TB predominantly affects the poor and marginalized and kills approximately 480,000 people every year in India. Simply put, this program is India’s war against TB,” said Junaid Ahmad, Country Director, World Bank. “The program draws on an unique partnership between Gates Foundation and the Bank in support of Government of India’s program on TB eradication.”
The progress of India’s TB program has substantial public health and economic development implications, both nationally and globally. Despite the steady progress of the India’s TB program, India contributes close to 27 percent of the global burden of TB—a proportion that has remained constant for over a decade. A high proportion of missed and mistreated cases fuel India’s TB epidemic. Despite a growing number of TB cases notified, India has an estimated million “missing” cases every year. These cases are not notified to the public system and most remain either undiagnosed or inadequately diagnosed and treated in the private sector. The overwhelming challenge facing TB control in India is delayed diagnosis and incomplete treatment, especially among patients treated in the private sector.
The program seeks to ensure that private sector providers adhere to established protocols of timely diagnosis, notification and effective management of TB. The program will provide financial incentives to private sector care providers for reporting cases of TB and ensuring that their patients complete the treatment regimen. It will also provide Direct Benefit Transfers (DBT) to patients for acquiring the critical nutrition needed during treatment. The program will help the Government of India strengthen the monitoring and implementation of Nikshay—the government’s web-based TB case monitoring system. In addition, the program will support the Ministry of Health and Family Welfare to strengthen institutional capacity and the Central TB Division to design and roll-out a performance-based management mechanism that strengthens central and state level TB control.
The program is built on strategic partnerships with the Global Fund to Fight AIDS, TB and Malaria, who are providing US$ 40.6 million to buy down the principal of the loan; and the Bill and Melinda Gates Foundation, who are financing independent verification of results achieved by the Ministry of Health and Family Welfare, and providing technical support to scale up private sector engagement. Such partnerships fulfil the kind of cooperation and innovative financing envisaged in the World Health Organization’s End TB Strategy.
“The program incorporates Indian and global best practices in private provider engagement for TB control, patient support interventions and capacity building. It is designed in close coordination with relevant development partners, including the Bill and Melinda Gates Foundation and the WHO,” said Ronald Upenyu Mutasa, World Bank Task Team Leader for the Program.
The $400 million loan from the International Bank for Reconstruction and Development has a 14-year maturity which includes a 5-year grace period.
 Uttar Pradesh, Maharashtra, Bihar, Rajasthan, Madhya Pradesh, Karnataka, West Bengal, Assam and Tamil Nadu