Major health reforms in the 1990s led to weakened public health efforts, but in the past decade, recommended tuberculosis control strategies have been expanded globally and stewardship of disease control has been strengthened. Such changes have been accompanied by innovations across core system functions in countries that we analysed, including: new financing in global health; SWAps to harmonise and rationalise resource flows; national financing schemes to extend access to essential services; addition of new cadres of health workers to reach poor communities; innovations for quality-assured supplies; and rollout of novel public-private approaches.