Prerequisite for a CoE in DR-TB care is that it should have a well-functioning designated Nodal DR-TB center.
Potential institutions are expected to have the following essential features:
Sustained Patient load: The Centre due to its reputation and service offerings should attract a sustained patient load for DR-TB related services in both inpatient as well as outpatient departments. 
Diagnostic services: Comprehensive diagnostic services for all types TB and DR-TB, including laboratory, radiology and clinical methods should be accessible to all patients reaching a CoE. Patients reaching the center should be receiving all necessary diagnostic services as per guidelines of NTEP. 
TB Treatment Services: The Centre should have the capacity to initiate all types of drugs and regimen available under the program. All investigations for Pre-Treatment Evaluation should be available at a CoE.  They should be able to assess progress to treatment and promptly adjust or modify the treatment regimen as per NTEP policy as needed. Facilities for managing DR-TB in patients of all ages, pregnancy and other special conditions should be present. In cases where patient shows indication of treatment failure/ intolerance or recurrence of TB/DR-TB and in complicated or difficult to treat cases, the center should have demonstrated ability to design appropriate regimen. 
Adverse Drug Reaction management: The Centre should have demonstrated ability to manage all types of ADRs.
Comorbidity Management: There should be facilities to diagnose/ workup and manage all types of TB comorbidities.
Counselling Services: The Centre should have demonstrated ability to inform and educate patients about diagnosis, treatment, ADR and prognosis of their condition using services of expert counsellors in a non-discriminatory and inclusive manner.
Recording and reporting: The center should have a robust system for creating and maintaining clinical records of its patients along with prompt update of details in Ni-kshay as necessary.
Infrastructure and HR:
•Airborne infection control measures: These center should comply with AIC guidelines 
•In-patient and Outpatient Services: The Center should have dedicated inpatient and outpatient departments for TB/ DR-TB. Outpatient services should be available throughout the week during working hours.
•Human Resources: The center should have in-place and trained human resources as per the guidelines and norms of NTEP with an emphasis on gender-responsive recruitment. 
•DRTB Committee: It should also have a functioning DR-TB committee that meets regularly and provides consultation for its cases. 
•Critical Care: The center should have ability to deal with critically ill patients due to TB/ DR-TB. This may be in the form of a TB Intensive Respiratory Care Unit with appropriate infection control measures and facilities or other methods to provide intensive life support and related care. 
•Research and evidence generation: The Centre may be performing various studies or research in clinical, technological, operational or implementation areas. 
It is highly desirable for a CoE to have the following
•Advanced diagnostic/ Treatment protocols –NTEP diagnostic and treatment protocols are standardized to consider the programmatic conditions that will be applicable all over the country. The Centre, however, may not be limited by this. They may adopt diagnostic and treatment protocols that are above and beyond the recommendations of the program to provide a more wholesome care to its patients. These need to be done with adequate approvals, documentation and rationale, and experiences from such extensions should be studied and published either as case studies/ series or as trials.
Advanced Surgical care in TB requires both advanced facilities and surgical expertise. These include lung resections, extra pleural thoracoplasty, extra pleural pneumolysis, thoracomyoplasty, pleurectomy and decortications of the lung; and so on. 
Palliative care: The Centre should be able to provide appropriate palliative care for patients with disability, advanced disease or poor prognosis related to TB as described in PMDT guidelines 2021. The Centre should have demonstrated ability to perform palliative care either in-house or through linked services. 
Pulmonary Rehabilitation: The Center should have a good pulmonary rehabilitation service catering to the needs of patients.