Our established city-wide enhanced TB surveillance system in Blantyre, Malawi indicates rapidly changing epidemiology, with accelerated declines in TB incidence and mortality. This electronic system could provide accurate and timely data for the Malawi National TB and Leprosy Elimination Programme (NTLEP). Additionally, in the absence of a formal address system, the clinic-based geolocation system (ePAL) provides the level of spatiotemporal detail required to efficiently track disease burden, and target and assess interventions as local epidemics become increasingly concentrated in vulnerable populations. Such systematic surveillance, together with real-time information on resource availability, if scaled up, will allow the NTLEP to better understand where to target resources, e.g. when to intensify case-finding methods and how best to target them. Additionally, this enhanced surveillance system will enable a robust assessment of such targeted interventions.