Building a system for training content development: Experiences from India's TB elimination programme

India's National TB Elimination Programme (NTEP) operates at an unprecedented scale, requiring training across a large, heterogeneous workforce while continuously adapting to evolving guidelines, diagnostics, digital systems, and service delivery approaches. Historically, training content was fragmented, difficult to update, and insufficiently tailored to diverse cadres. In response, NTEP adopted a systems-thinking approach to redesign training as part of a broader programme ecosystem and developed a Modernized Training System (MTS). This paper describes the conceptualisation, design, implementation, and early outputs of the Content Development System (CDS), the content subsystem of the MTS.

A programme-led Training Needs Assessment informed the functional requirements of the CDS. The system was designed around granular, competency-linked learning objectives organised into a structured knowledge architecture consisting of nodes, content pages, and cadre-specific curricula. The CDS incorporated governance and quality assurance mechanisms involving content creators, reviewers, and maintainers, while enabling multilingual content development, version control, interoperability with learning management systems, and continuous updating.

The CDS enabled the assembly of 23 cadre-specific courses (13 approved and 10 under development), organised through 935 chapters and 217 modules, yielding over 400 h of curriculum aligned to programme competencies. The system established a knowledge architecture comprising 2498 knowledge nodes, of which 1472 were live, 989 under review, and 37 deprecated, supported by 3505 content pages and over 175 h of unique training material. Content was developed in multiple languages, including English, Marathi, Telugu, Gujarati, Hindi, and Tamil. Over 51,700 revisions were recorded over three years, supporting continuous quality improvement and updating. The CDS was implemented nationally and supported training of over 30,000 personnel.

The CDS demonstrates a scalable, systems-based approach to modernising training content development within a national public health programme. By enabling standardisation, rapid updating, multilingual delivery, and competency-based curriculum assembly, the system offers a replicable model for strengthening training systems in tuberculosis and other large-scale health programmes.