The World Health Organization (WHO) has identified 25 countries as heavily struck by the tuberculosis misery. Pakistan came sixth in this list. High death and disease rates have put the Pakistan National TB Control Program in question. The performance is weak and its impact on reducing the burden of TB is low. This dissertation focuses on factors that contribute to it, analyses gaps, and urges more extensive research on the issue to prevent more lives be wasted due to TB. Research uses the examples of other 22 high burden countries and advice the health authorities to overcome this challenge.