A systems approach in modernizing the training operations: Experiences from India's National TB Elimination Programme.

BACKGROUND: To guarantee the access, coverage and quality of the TB Services, India's National TB Elimination Programme (NTEP) depends on a large, diverse health workforce operating at national, state, and district levels. This workforce requires continuous training to align with the rapidly evolving programmatic needs. In the past, training delivery was fragmented across multiple institutions utilizing varied curricula and platforms, constrained by limited infrastructure, non-standard training time, and weak monitoring of training quality and outcomes. Aligning with the National Strategic Plan for TB Elimination (NSP 2017-25) and informed by a structured Training Needs Assessment (TNA), the Modernized Training System (MTS) comprising three subsystems addressing Training content development, Training Delivery and related operations, and Monitoring and Evaluation of trainings was developed. This paper describes the design, implementation, and early outcomes of the Training Operations subsystem of the MTS. METHODS: A clear hierarchy of training institutions, namely- National Institutes, State TB Training and Demonstration Centres, and District TB Centres formed the basis to design the Training Operations subsystem. Each of these institutions are responsible for training designated cadres, and are supported by the Master Trainers, Trainers, and Training Coordinators. An annual planning tool guided the scheduling of different types of training, viz. Induction, Update, and Refresher training based on individual training needs. A blended learning model combining self-paced content, virtual webinars, in-person sessions, demonstrations of processes and procedures, field visits, and role-plays; a standalone chatbot-based tool- Nikshay Setu, for continuous on-job learning forms the backbone of the subsystem. A dual-level Internal and External Quality Assurance framework for monitoring training delivery and outcomes ensures standard training quality. The system integrated a Learning Management System, Swasth-eGurukul, for training content delivery, assessments, and certification. RESULTS: Three national institutes and five state-level training institutions deployed the training Operations subsystem initially. The operations were scaled up one cadre at a time based on content availability from the Content Development System. Between 2023 and 2025, the system delivered 381 training batches across 11 cadres, training 30,830 personnel. Training volume varied by cadre, ranging from single batches for specialised cadres such as PPM Coordinators to 141 batches for ASHA/Community Health volunteers, being the largest cadre with 20,785 personnel trained. The system has been fully transitioned to NTEP for long-term operational use and sustainability. CONCLUSION: The architecture of the Training Operations subsystem exemplifies a structured, technology enabled approach to standardizing training delivery, integrating blended learning, digital tools, and with established quality assurance within a large national public health programme. The training of 30,830 staff across 11 cadres within three years shows that country-wide implementation is feasible. The system offers a replicable model for modernising training delivery in other large-scale, multi-cadre health programmes.