•The day-to-day administration of the CoE and its functions will be the responsibility of the concerned institution; the NDR-TBC committee at CoE may govern the functioning of the CoE.
•Head of the Institution would oversee the CoE activities and may nominate a chest physician as nodal officer for operational aspects. 
•CoE would also be supported by the NTEP key staff (Medical Officer, Statistical Assistant, Counsellor for NDRTBC and additional Medical Officer, Lab Technician, TB Health Visitor if it’s a medical college) already posted at the institution.
•Overall coordination between HUB and SPOKES would be carried out by NTEP Medical Officer/staff posted in the CoE under the guidance of Nodal Officer.
•DRTBC committee at the Spokes will be responsible to ensure participation of spokes in all the activities. Head of the institution may nominate a chest physician as nodal officer for operational aspects at spokes. The NTEP Key staff (Medical Officer, Statistical Assistant, Counsellor for NDRTBC and additional Medical Officer, Lab Technician, TB Health Visitor if it’s a medical college) at NDRTBC and District Senior DRTB coordinator need to support the activities of the spokes as per the guidance of the Nodal Officer. 
•All CoEs & spokes need to be equipped with virtual interaction platforms.

Capacity building of Hubs & Spokes
Capacity of clinicians, nursing personnel and health care providers of the CoE in the areas of DR-TB care need to be built.  

CTD will coordinate specific trainings on:-

(1) Programmatic Management of DR-TB in India 

(2) Counselling skills 

(3) Mental status assessment of DR-TB patients 

(4) ADR management 

(5) Airborne Infection Control 

(6) Data management for the identified staff at CoEs enabling the trainees to manage DR-TB in more efficient and competent manner and also to train others. CoEs need to plan the cascade trainings within the institute in co-ordination with the state NTEP.

Routine training of all staff at SPOKE institutions need to be undertaken through state NTEP & State TB Training & Demonstration Centers (STDC) with the help of the facilitators from the CoE.

Recording and Reporting
All patient related data to be entered in NI-KSHAY at both hubs and spokes on a real time basis. Apart from the records and documents mentioned in the PMDT guidelines, a proper log of documentation of the referrals, consultations, capacity building and mentoring sessions held (phone logs/e mail record/ video interaction logs) should be maintained at all Hubs and Spokes. A quarterly report need to be prepared by the Statistical Assistant/NTEP Key staff at the CoE and submitted to Central TB Division through the State TB Officer.  

Financial Assistance 
NTEP has provided a Senior Medical Officer, a Statistical Assistant, and a Counsellor at all NDR-TBC. In addition, all medical colleges have the provision of MO-Medical College (1); TB health visitor (1) and Lab Technician from the NTEP program. Their services could be utilized for conducting various activities as CoEs. Establishment of virtual interaction platforms at all hubs and spokes will be temporarily supported through the developmental partners working with NTEP. Diagnostics and treatment services including drugs for DR-TB management will be provided to the hubs and spokes as per the norms of NTEP. There are no other additional resources required for a CoE /spokes other than that required for an ideal NDRTBC. If the institution requires additional resources to demonstrate any of the components of an ideal NDR-TBC, the resources could be mobilized from various sources including state health budget, NHM PIPs, support from the developmental partners working for institutional strengthening, various project-based funds/grants or through CSR grants/ support.

Ancillary/Support Services for CoEs & Spokes
Ancillary/support services like lab, radiology, drugs for managing co-morbidity/adverse drug reactions, CSSD, mechanized laundry is ideally available in the facility and should be made available to the DR-TB patients also.