In the narrow lanes of India’s slums, life moves fast — but healthcare often moves too slow. Amidst the constant buzz of daily survival, Tuberculosis (TB) continues to quietly spread, trapping thousands in a cycle of poverty and illness. TB doesn’t discriminate, but poverty, overcrowding, and poor living conditions make urban slums a breeding ground for this ancient disease. While India has made great strides toward its TB Mukt Bharat 2025 goal, its battle is far from over — especially in cities where invisible barriers prevent the most vulnerable from getting timely diagnosis and treatment. A hidden epidemic in urban shadows India is home to nearly 11 million people living in slums across its major cities, as per the Census of India¹. These densely populated settlements — where multiple families often share a single room — create perfect conditions for TB transmission. According to the India TB Report 2024, urban areas account for about 38% of India’s TB cases, with many originating in slum clusters². In places where sunlight barely reaches and ventilation is scarce, airborne TB bacteria can linger — spreading from one coughing individual to dozens.
The World Health Organization (WHO) notes that poor housing, malnutrition, and limited healthcare access are among the strongest risk factors for TB³. For urban slum dwellers, all three combine into a perfect storm.

Why TB thrives in slums
TB spreads through the air — not by touch or food — when someone with active TB coughs, sneezes, or talks. But the environment determines how far and fast it goes.
In India’s slums:
 Families live in cramped, poorly ventilated spaces.
 Unhygienic conditions weaken immunity.
 Nutrition is poor, making bodies less resistant.
 Daily wage jobs leave little time for doctor visits.
 Stigma discourages people from seeking treatment early.
A study by the Indian Council of Medical Research (ICMR) found that nearly one-third of slum residents with prolonged cough delay medical consultation by over four weeks, often mistaking TB symptoms for common colds or workplace dust⁴. By then, transmission to family or neighbours may have already occurred.

Barriers beyond biology

TB control in slums is not only about medication — it’s about mindset and infrastructure.

1. Fear of Losing Work: For many, taking time off to visit a TB clinic means losing daily income. As a result, patients delay treatment or drop out midway.
2. Lack of Privacy: In overcrowded communities, people worry about being labelled as “infectious.” This social fear often overshadows the fear of the disease itself.
3. Limited Access to Quality Care: Even in cities with hospitals, public health services are often far from slum areas, while private clinics are unaffordable.
4. Low Awareness: A National Family Health Survey (NFHS-5) finding shows that only 65% of urban poor adults know that TB is curable⁵ — a reminder of the urgent need for better health education.

Turning challenges into change
India’s fight against TB in slums is not lost — it just needs innovation, integration, and inclusion. The National TB Elimination Programme (NTEP) has introduced several initiatives that specifically target urban TB hotspots:
 Active Case Finding (ACF): Health workers go door-to-door in slum communities to screen for symptoms.
 Ni-kshay Mitra Initiative: Encourages individuals, corporates, and NGOs to adopt TB patients and provide nutritional support.
 Mobile Diagnostic Vans: Equipped with digital X-ray and GeneXpert testing, these vans bring diagnostic facilities closer to communities.
 Urban Health Missions: Integrate TB services with primary healthcare in slum areas. The WHO Global TB Report 2023 also encourages countries to engage local communities and NGOs to address stigma and ensure continuity of care⁶.

Stories of hope from the heart of the city
In Mumbai’s Dharavi — one of Asia’s largest slums — a pilot project under the BMC and the Central TB Division reported a 15% increase in early TB detection after launching door-to-door screening and counselling⁷. Similarly, in Delhi and Kolkata, NGOs working with the Urban Primary Health Centres have shown how community-led awareness sessions and nutrition support help improve treatment completion rates. These examples prove that when the community leads, TB retreats.

TB in urban slums: Fast facts

38% of TB cases in India occur in urban areas² Malnutrition and poor housing are key risk factors³ Delay in seeking care: 1 in 3 slum residents waits over 4 weeks⁴

TB is 100% curable with full treatment adherence Community participation is the key to elimination Building TB-free cities, One neighbourhood at a time
Eliminating TB in slums is not just a medical mission — it’s a moral imperative. Cities cannot be called developed if their most vulnerable citizens remain trapped in disease and stigma.
What can we do?
 Empower community health workers to conduct local screening.
 Promote awareness in schools and self-help groups.
 Ensure proper ventilation and sanitation in housing projects.
 Support Ni-kshay Mitra initiatives that provide nutrition and counselling.
With combined efforts from the government, private sector, NGOs, and citizens, we can turn India’s urban underbelly into the backbone of TB elimination.
Key Takeaways
 TB thrives in overcrowded, poorly ventilated environments — common in slums.
 Awareness, nutrition, and access to healthcare are as vital as medicines.
 Active screening and mobile diagnostics are game-changers.
 Stigma and delayed diagnosis remain major barriers.
 TB is completely curable — but only when treatment is completed.
This is an educational initiative supported by Mylan Pharmaceuticals Private Limited (a Viatris company).

References:

1. Census of India. Urban Slum Population Data. https://censusindia.gov.in/
2. Central TB Division, MoHFW. India TB Report 2024. https://tbcindia.mohfw.gov.in/
3. World Health Organization (WHO). Global Tuberculosis Report 2023.
   https://www.who.int/publications/i/item/9789240078467
4. Indian Council of Medical Research (ICMR). Community Health Studies on Urban TB Delay.
   https://main.icmr.nic.in/
5. National Family Health Survey (NFHS-5). Key Health Indicators – Urban Data.
   http://rchiips.org/nfhs/factsheet_NFHS-5.shtml
6. World Health Organization. Community Engagement for TB Control.
   https://www.who.int/teams/global-tuberculosis-programme
7. Brihanmumbai Municipal Corporation (BMC). Dharavi TB Pilot Impact Report, 2023.
   https://portal.mcgm.gov.in/