Integrated tuberculosis-multimorbidity management in India: A SWOT analysis

Tuberculosis multimorbidity is an emerging burden to the healthcare system in India, but the national programmes like the National TB Elimination Programme (NTEP), the National Programme for Prevention and Control of NCDs (NP-NCD), and the National Mental Health Programme (NMHP) are still operating in silos, leading to fragmented and inefficient care. This paper employs a SWOT (strengths, weaknesses, opportunities, threats) analysis to evaluate the integration potential of these programmes within the platform of Ayushman Arogya Mandirs (AAMs). The analysis identifies key strengths, such as NTEP's robust surveillance and NP-NCD's wide screening network, and critical weaknesses, including isolated digital platforms and a lack of cross-programme training for health workers. Significant opportunities exist through linking digital systems like Ni-kshay and the NP-NCD application, and training frontline workers in composite care. Major threats include persistent policy fragmentation and patient stigma. We conclude that a strategic shift from vertical, disease-specific programmes to a person-centred, integrated model is essential. This requires collaboration at the policy level, the integration of comprehensive digital health records, and the delegation of responsibilities to primary care teams, including AAMs, to effectively manage multimorbidity, improve patient outcomes, and advance India's goals of attaining Universal Health Coverage of tuberculosis.