Community empowerment in tuberculosis elimination

In public health, meaningful community engagement has consistently been linked to improved access to timely diagnosis, strengthened treatment adherence, reduced stigma, and better overall health outcomes, particularly among marginalized and underserved populations. Effective engagement fosters trust, enhances service utilization, and promotes sustained care-seeking behaviour. However, genuine empowerment extends beyond simple participation in health programs; it encompasses the ability of communities to influence local governance processes and address broader social determinants such as nutrition, sanitation, education, and livelihood security, while functioning as a dynamic and transformative process that shifts communities from passive beneficiaries to active agents of health action. Community empowerment operates through interconnected logistical and psychological pathways. Logistical support improves access to diagnosis, treatment continuation, and linkage with health systems, while psychosocial reinforcement through peer support and survivor engagement strengthens motivation, reduces internalized stigma, and sustains long-term adherence. At the same time, empowerment is shaped by local socio-economic realities, including poverty and livelihood insecurity, and may face risks such as volunteer burnout, stigma toward community workers, inequitable reliance on unpaid labor, and limited financial sustainability-underscoring the need for ethical safeguards and social protection. Tuberculosis (TB) remains a major global public health challenge despite the availability of effective chemotherapy. According to the World Health Organization, TB continues to affect millions annually and remains a leading cause of infectious disease mortality worldwide. Within the End TB Strategy, community engagement and civil-society participation-including contributions from national and nongovernmental organizations-are recognized as critical to sustainable TB control. TB elimination therefore requires not only biomedical interventions but also ethically supported, economically feasible, and institutionally sustained community empowerment capable of transforming participation into shared ownership of tuberculosis control.