India bears the world’s highest tuberculosis (TB) burden, accounting for 26% of global cases with an estimated 2.8 million incidence in 2023, even as national case notifications reached a historic high of 2.55 million. While the National Tuberculosis Elimination Program (NTEP) funds core clinical, diagnostic, and surveillance functions, and partnering non-profits drive community-level implementation, achieving the country's ambitious elimination goal requires addressing major funding gaps in critical social determinants. Specifically, key patient-centered services that directly influence treatment outcomes— such as livelihood restoration, transport assistance, and enhanced nutritional support to combat undernutrition, a mutually reinforcing TB risk factor—remain fragmented and largely excluded from core NTEP budgets.
India's Social Stock Exchange (SSE) offers a new, regulated pathway to close this gap. Established by the Securities and Exchange Board of India (SEBI) and operationalized on the National Stock Exchange (NSE) and Bombay Stock Exchange (BSE) since 2022, the SSE enables eligible social enterprises, including NPOs, to raise capital from social investors and donors under a transparent disclosure and impact-reporting framework. For NPOs, the primary instrument is the Zero Coupon Zero Principal (ZCZP) instrument — a regulated donation-like security that carries no interest and no principal repayment, issued for a defined social project with mandatory use-of-proceeds, annual impact reporting, and independent social audit. In May 2026, the Ministry of Corporate Affairs amended Schedule VII of the Companies Act, 2013 to permit Corporate Social Responsibility (CSR)–mandated companies to subscribe to ZCZP instruments on the SSE, subject to a cap of 10% of annual CSR expenditure, further expanding the potential subscriber base.
Despite this enabling framework, TB-focused NPOs face-significant institutional challenges to participating in the SSE. Most of them lack the technical, compliance, and transactional capacity to navigate SSE registration, prepare a Fund-Raising Document (FRD), satisfy social audit requirements, and build an investor subscription pipeline. No dedicated institutional support mechanism currently exists to shepherd a cohort of TB NPOs through the full SSE listing journey. This is the gap that U.S. foreign assistance is uniquely positioned to fill, providing catalytic, time-bound institutional support that unlocks a sustainable domestic financing channel for TB elimination.