Finding the Missing TB Patients

Despite rapid economic transformation over the last three decades, the state of Haryana has witnessed high rural-urban disparity with respect to access to quality healthcare. While the status of health infrastructure in Haryana is better than the national average, the provisions of healthcare facilities are largely concentrated in few pockets and locations in urban centers. About 92% of total hospitals in the state are located in urban areas. This, when 70% of the state’s total population of 25 million souls (Census of India, 2011) reside in rural areas. In addition, there is a large marginalized migrating population, which is often unable to leave their daily wage jobs to access quality healthcare.

Most peripheral public health facilities – Primary and Community Health Centers (PHCs & CHCs) rely on one of the cheapest and quickest ways to screen TB patients – sputum microscopy. Due to high level of skills required in sputum microscopy upto half of the cases my go undetected. Medanta Hospital – one of India’s largest super speciality hospital located in Haryana, stepped in to reach the unreached – identify the missing sputum negative TB cases in Haryana.


Mission TB Free Haryana, launched in 2015, is a public private partnership between the Government of Haryana and Medanta Hospital to increase access to TB care in rural Haryana. Medanta’s tripartite intervention model is hinged on strengthening the robust National TB Program by finding missing TB patients and establishing linkages between the patients and the government health care and treatment Medanta has mobilized over Rs. 30 million for the project.

Three-pronged intervention strategy

Championing pvt-pvt partnerships X-Ray Tests at rural government health facilities

Medanta identified and activated corporates that shared their values – Siemens, Oriental Bank of Commerce, RJ Corps, Philips, RITES — who financed 3 vans fitted with X-Ray machines. The strategy was to complement the existing government system with additional diagnostic infrastructure. These X-Ray vans move across a cluster of districts in a cyclic manner, dedicating 4-6 weeks to each district, supporting each PHC/CHC by conducting X-rays of presumptive patients for almost a week and then returning again within 6-8 months to it. The routes of the vans are designed in consultation with the District TB Officers.

Enhanced case finding Community outreach camp

Community outreach activities is the second strategy to essentially spread awareness, screen and test anyone who is chest symptomatic. Community is informed ahead of the camp, using the help of the front line health workers like ASHA, ANMs who are essentially the link between the community and health services. Vans fitted with confirmatory, CBNAAT tests serve as a missing link. State-of-the-art services are delivered right at the doorstep of patients, reducing the delay in diagnosis.

Active case finding Door to door screening

The third strategy, added in November 2019 upon becoming a CTP Member, ensured 100% population coverage. Launched in a block of Pataudi, a team equipped with a questionnaire covered entire the block through door-to-door screening and identified patients. Local level stakeholders like ASHA workers, sarpanch and civil society organizations are engaged via meetings, workshops, etc. to increase awareness and community ownership. The entire continuum of care – awareness, screening, diagnosis, treatment and counselling for adherence, is offered in the block.


The X-ray vans have provided screening support across 19 of the 22 districts of the state. Of the total no. of people screened, about 30% had abnormal X-Rays and around 10% have been moved to the Directly Observed Treatment, Short-Course (DOTS) program said Dr. Bornali Dutta, Project Lead, Mission TB-Free Haryana. The success of the intervention is proven by the project being scaled up in 4 additional states of India – Uttar Pradesh, Rajasthan, Jharkhand and Meghalaya.

Key Lessons

The model showcases that supporting the National government program by converging resources and filling gaps has proven successful. The project identified innovative solutions, effectively utilized resources available and mobilized additional funds from CSR kitties. This then, led to scaling up the project to include active case finding and a comprehensive approach in Pataudi block.