Health Systems for TB (​​HS4TB)

Launched in 2020, USAID’s Health Systems for Tuberculosis (HS4TB) project supports high TB burden countries with financing and governance strategies, tools, and approaches to achieve TB elimination goals. A five-year Task Order under an IDIQ, the project is currently working in Bangladesh, Ethiopia, India, and Kenya, where it supports policy reforms for increased and improved domestic contracting of TB services, greater domestic financing, and more efficient use of resources, while building in-country financial and managerial skills and leadership. HS4TB is also engaged in two global activities to strengthen sustainable financing for TB. Together, these interventions contribute to global efforts to meet the ambitious TB targets outlined in Sustainable Development Goal 3.

In Bangladesh, HS4TB is supporting the government to design and implement a pathway for government-funded procurement of TB services through competitive contracting with non-government entities. After conducting an assessment based on this framework, the project assisted the government to develop a roadmap for establishing domestic contracting and to define a regulatory pathway and plans for piloting. This process has also been documented in a case study, technical highlight, and policy brief.

In Ethiopia, the project is leveraging ongoing health reforms to assist the national government in establishing a co-financing approach and improved domestic financing for essential health services, including TB. To date, this work has been documented in an inception report and a TB Domestic Resource Mobilization and Sustainability Roadmap.

In India, HS4TB is working with the Central TB Division (CTD) and governments in five states to improve government contracting of private sector agencies and network intermediaries providing TB support services. Expected outcomes include increased TB service coverage, increased responsiveness to program needs, and more timely contracting and payment processes. HS4TB is also establishing innovative financing mechanisms to help private TB contractors to access working capital.

In Kenya, the project is supporting the National Tuberculosis, Leprosy, and Lung Disease Program (NTLD-P) to: develop a TB financing roadmap; assess the planning and budgeting capacities of county-level TB coordinators; develop related training materials for county-level TB resource mobilization; institutionalize a TB financial resource tracking tool at the county level; and assess the potential for contracting out selected TB services to private organizations.


HS4TB has published a technical report on the state of TB financing, the economic case for the TB response, and the interdependence between health and the economy.


In ongoing work, HS4TB is conducting a study on current approaches to establish the contracting of health services to non-state providers (by identifying promising legal, regulatory, policy, procedural and operational practices). Additionally, HS4TB is piloting a global TB Sustainability Index, a set of indicators on various dimensions of TB financing and governance that will help countries assess and ensure sustainable financing of their TB programs.