Evolution of TB programmatic information systems in India.

The development of tuberculosis (TB) programmatic information systems in India reflects the broader evolution of health information systems from paper-based reporting to integrated digital ecosystems. This paper documents three major phases in that evolution: the management information system era led by EpiCentre, the electronic case registry era under Nikshay V1, and the current transaction-based ecosystem represented by Nikshay V2. Each phase emerged in response to changing programme needs, technological capabilities, and expectations for data quality, timeliness, and operational usefulness. EpiCentre supported structured quarterly reporting from TB units but depended heavily on manual consolidation, delayed reporting cycles, and triangulation across multiple registers. Nikshay V1 introduced case-based digital registration and enabled more flexible reporting across the programme hierarchy, but it also exposed limitations related to change management, incomplete transition from legacy systems, and persistent data quality challenges. Nikshay V2 marked a conceptual shift from reporting systems to transaction-based architecture, linking service delivery events across the TB care cascade through lifecycle-based records and interoperable applications. This architecture enabled integrated workflows for diagnostics, treatment, adherence support, direct benefit transfers, call centre services, and automated dashboards. However, the transition also created new challenges, including continuous adaptation requirements, user learning burdens, validation with external data sources, and the need for stronger analytical conventions. The experience shows increasing prioritization of interoperability, field level usability, automation of reporting, generation of insights, and facilitation of programmatic decisions, while boldly transitioning between system versions. Lessons from this experience of maturing information systems toward a transaction-based architecture may be replicated elsewhere.