Council for International Relations & Diplomacy
A Research Study by The ChangeMakers Magazine
Executive Summary
Bhiwandi — Maharashtra’s powerloom capital, home to an estimated five lakh-plus power looms and over 225 sizing, dyeing and processing units — sits at the intersection of two crises that rarely get discussed together: a national tuberculosis (TB) elimination mission and one of the region’s worst industrial air-quality emergencies. This study examines the Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA) as a national framework, and asks a question that neither the health bureaucracy nor the industrial-regulatory apparatus in Bhiwandi appears to have formally answered: is Bhiwandi’s TB burden being driven, in part, by chronic occupational and ambient exposure to sizing and dyeing dust and emissions — and is the PMTBMBA structured to detect this?
The finding, based on available public evidence, is that Bhiwandi has a well-documented pollution crisis and a well-documented national TB programme, but there is no visible, publicly reported bridge between the two — no dust-exposure screening protocol for powerloom and sizing-unit workers under PMTBMBA in Bhiwandi, and no published local TB-notification data disaggregated by occupation. This gap is itself the central finding of this study and the basis of its recommendations.
1. Background: What the PMTBMBA Actually Is
The Pradhan Mantri TB Mukt Bharat Abhiyaan was launched by the President of India on 9 September 2022, envisioned to mobilise community stakeholders — individuals, corporates, NGOs, political representatives — as “Ni-kshay Mitras” who adopt and support TB patients through nutritional and social assistance during treatment. The initiative was designed to address the complex needs of persons with TB by combining community support with the existing National TB Elimination Programme infrastructure. Under the scheme, District TB Officers share lists of consenting patients with Ni-kshay Mitras on the 23rd of every month, and the Mitras are responsible for ensuring agreed nutritional and other support reaches patients on schedule.
Shri Anmol Sagar IAS, Commissioner, BNCMC
The nutritional component matters clinically, not just socially: undernutrition support under the linked Nikshay Poshan Yojana is understood to improve treatment outcomes and reduce the risk of relapse and mortality among people with TB. Patients also receive ₹1,000 per month in nutritional assistance and can access cashless hospitalisation through Ayushman Bharat where required.
A revised, intensified phase of the campaign was rolled out in late 2025–2026, with a design that explicitly targets “TB-vulnerable high-risk villages and wards” through a mix of outreach health camps and facility-based screening that bundles TB testing with non-communicable disease checks — diabetes, hypertension, BMI, anaemia — on the reasoning that these comorbidities heighten the risk of progression from latent infection to active TB disease. District Magistrates and Chief Medical Officers are designated as nodal officers responsible for identifying and prioritising these vulnerable clusters.
Nowhere in the publicly available campaign framework, however, is occupational dust exposure — from textile sizing, dyeing, powerloom lint, or industrial combustion — named as a vulnerability criterion, despite a body of Indian clinical literature that says it should be.
2. Bhiwandi’s Industrial Profile: The Scale of Exposure
Bhiwandi’s economy is built on power-loom weaving supported by a dense cluster of ancillary sizing (starching/warping) and dyeing units. Documented studies count more than five lakh power looms in the city alongside upwards of 225 dyeing, printing and processing units, of which around 45 are large-scale dyeing and printing operations. These units are concentrated in dense residential-industrial mixed zones, meaning exposure is not confined to factory floors — it extends into surrounding neighbourhoods.
Reporting from earlier this year documented Bhiwandi’s air quality collapsing into the “very poor” category, with the AQI reportedly touching 312 and PM2.5 concentrations measured at nine to eleven times the WHO’s recommended safe limits. Residents across the city reported breathing difficulties, throat irritation and eye problems as industrial emissions combined with unchecked construction dust. Local residents specifically implicated the large number of sizing and dyeing units operating across the city, alleging that several of these units burn plastic waste and release toxic fumes through their chimneys.
A related account of the same period found the pollution reaching residential interiors: residents in Ashok Nagar, Gopal Nagar, Temghar and Mansarovar reported smoke infiltrating even upper-floor apartments and degrading indoor air quality, with a cluster of sizing, dyeing and plastic-processing units — several of them allegedly burning industrial and plastic waste — identified as the primary source. Urban planners cited in that reporting warned that without intervention, sustained PM2.5 exposure at these levels could burden the healthcare system and compromise liveability across the industrial corridor.
This is consistent with earlier scientific findings on Bhiwandi’s dyeing-unit effluent load, which documented severe untreated organic and suspended-solid pollution levels even after treatment, from a cluster this study describes as one of the largest textile-dyeing concentrations in the district.
3. The Clinical Pathway: How Occupational Dust Exposure Elevates TB Risk
This is the connective evidence that a Bhiwandi-specific TB programme needs to account for, drawn from research conducted elsewhere in India and internationally.
3.1 Silica dust and TB. Occupational exposure to crystalline silica dust is one of the most firmly established risk multipliers for pulmonary tuberculosis in the global literature. Workers with long-term silica dust exposure — even without diagnosed silicosis — face an elevated risk of developing TB, and free silica is understood to impair the ability of lung macrophages to contain and kill tubercle bacteria, weakening the lung’s natural defence against infection. A Rajasthan sandstone-mining study found substantial overlap between the two conditions: of 174 mine workers screened, 37.3% had silicosis, 10% had active tuberculosis, and 7.4% had combined silico-tuberculosis, with abnormal spirometry findings in nearly 90% of the workforce studied.
3.2 Byssinosis and TB — the specific powerloom pathway. Byssinosis, the chronic respiratory disease caused by inhaling cotton and textile fibre dust, is directly relevant to Bhiwandi’s home-based and factory-based powerloom workforce. A Madhya Pradesh field study of home-based powerloom workers — the closest available analogue to Bhiwandi’s own worker population — found byssinosis-like symptoms in 98% of those screened, and among the subset with these symptoms, 11% also tested positive for tuberculosis. That same body of work notes that powerloom workers face compounding occupational hazards beyond dust alone — exposure to hazardous chemical substances from thread treatment, prolonged manual working hours and chronic noise exposure — all of which can further weaken respiratory resilience. An earlier clinical study of a Bombay textile mill similarly confirmed meaningful byssinosis prevalence among Maharashtra’s own textile workforce, despite decades in which official records failed to register the disease at all.
3.3 Environmental (non-occupational) dust and air-pollution links. The risk is not confined to those working directly with dust. Broader research into ambient air pollution has found a growing evidence base connecting particulate exposure to TB incidence at the population level, and case-control work on coal-dust-exposed communities in China found meaningfully elevated active pulmonary TB risk among those with pre-existing dust-related lung damage. This matters directly for Bhiwandi, where PM2.5 levels reported this year were measured at up to eleven times WHO limits in residential areas adjacent to sizing and dyeing clusters — meaning the exposed population plausibly extends well beyond registered industrial workers to residents living near these units.
3.4 The diagnostic blind spot. A 2024 mixed-methods study on India’s own TB-prevention guidelines makes the structural point most relevant to this study: although India’s 2021 TB preventive-treatment guidelines formally recognise silicosis as a screening-priority group, testing for latent TB infection among silica-dust-exposed workers remains significantly under-implemented in practice, despite an estimated 52 million Indians working in silica-dust-exposed occupations nationally. If this gap exists at the national policy-implementation level, there is no reason to believe Bhiwandi — with no publicly documented dust-specific TB screening protocol — is an exception.
4. Findings Specific to Bhiwandi
- No published, occupation-disaggregated TB data for Bhiwandi is publicly available. State and national TB dashboards report district- and taluka-level notification figures, but this study could not locate any published breakdown identifying powerloom, sizing or dyeing workers as a distinct risk category within Thane district’s TB notifications — a gap that itself constitutes a finding.
- PMTBMBA’s vulnerability criteria do not name industrial dust exposure. The campaign’s intensified 2025–2026 framework targets high-risk villages/wards and clinically vulnerable groups (diabetes, hypertension, anaemia, the elderly) for outreach screening, but does not list occupational dust exposure — despite it being a recognised, guideline-acknowledged TB risk factor in India.
- The pollution and the workforce occupy the same physical space. Sizing and dyeing units are not isolated on an industrial periphery; residential reporting from Bhiwandi describes smoke reaching upper-floor apartments in named residential pockets, meaning any TB screening strategy built around “vulnerable wards” should, on the available evidence, already include these neighbourhoods — whether or not dust exposure is formally named as the trigger.
- Bhiwandi’s Nikshay Mitra / community-adoption uptake is not separately reported, unlike states such as Karnataka and Himachal Pradesh, where district-level adoption numbers are actively publicised as an accountability measure. The absence of comparable Bhiwandi/Thane-specific public reporting limits independent civic scrutiny of how the scheme is actually functioning on the ground.
5. Recommendations
For the Municipal and District Health Administration (BNCMC / Thane District TB Office):
- Formally add occupational dust exposure (powerloom, sizing, dyeing) as a vulnerability marker within PMTBMBA outreach camps operating in Bhiwandi, in line with the national programme’s own stated logic of targeting comorbidity-linked vulnerability.
- Commission or publish an occupation-disaggregated TB notification analysis for Bhiwandi taluka, comparable to the Rajasthan and Madhya Pradesh studies cited above.
- Integrate chest X-ray and spirometry screening into existing industrial-health inspections of sizing and dyeing units, rather than treating TB screening and pollution-control enforcement as unconnected regulatory tracks.
For MPCB and Municipal Pollution Enforcement:
- Treat the documented PM2.5 exceedances near residential clusters as a public-health input to TB vulnerability mapping, not solely an environmental-compliance matter.
- Investigate and act on the specific, repeated public allegations of plastic-waste burning by sizing and dyeing units, given the compounding respiratory toxicity this adds beyond textile dust alone.
For Civil Society, Ni-kshay Mitras and The ChangeMakers Magazine’s continuing coverage:
- Press for public disclosure of Bhiwandi/Thane-specific PMTBMBA adoption and screening numbers, on the model of states that already publish this data.
- Continue documenting the residential-industrial overlap in wards such as Ashok Nagar, Gopal Nagar, Temghar and Mansarovar as part of sustained investigative coverage linking environmental and public-health accountability.
6. Conclusion
Bhiwandi does not lack for evidence of a problem — its air-quality crisis is well documented, its sizing and dyeing cluster is well documented, and the general clinical link between occupational dust and tuberculosis is well established in the Indian medical literature. What is missing is the administrative act of connecting these dots inside the PMTBMBA framework itself. Until Bhiwandi’s TB elimination effort formally treats its powerloom and sizing-dyeing workforce — and the residents living beside these units — as a distinct, named risk population, the city’s participation in India’s TB-Mukt Bharat mission will remain structurally incomplete, regardless of how many Ni-kshay Mitras are enrolled on paper.
This study synthesises publicly available government campaign documentation, peer-reviewed clinical literature, and contemporaneous reporting on Bhiwandi’s air quality as of September 2026. It is intended as a starting framework for further investigative and policy work by The ChangeMakers Magazine, and does not substitute for primary epidemiological fieldwork, which this study recommends the municipal and district health authorities undertake.
