Tuberculosis (TB) is a major public health and development challenge in Pakistan. In 2010, the WHO ranked Pakistan among the five countries with the largest number of TB cases; every year more than 460 000 new
cases and 60 000 TB-related deaths occur in the country. As the government of Pakistan invests to reduce TB, TB managers have an important role in effective implementation of the Stop TB strategy. As such a qualitative interview study was conducted with 10 national and provincial programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (6 national staff and 4 from provincial level). The managers reported that most progress had been made in extending DOTS, health systems strengthening, public–private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were: the availability of DOTS services, the public–private partnership approach, comprehensive guidance for TB control and Government and donor commitment to TB control. The three main challenges were: inadequate political commitment, prioritization of certain components and limitations in the overall health system. The recommendations to the health authorities for improving the TB control programme are to enhance political commitment, increase public–private partnerships and evaluate and improve implementation of specific components.