Tuberculosis remains one of the world’s oldest and most stubborn infectious diseases, yet the way health systems respond to it is often dogged by modern challenges. Clinics are overcrowded, families must travel long distances, and children with vague or non-specific symptoms are frequently overlooked. For decades, tuberculosis care has been organised around hospitals and specialised facilities, even though the disease itself spreads and takes root in homes and communities. A growing body of research now argues that this mismatch is costing lives, particularly among children. Decentralised models of care, which bring services closer to families and empower community-based health workers, offer a compelling alternative. Recent evidence from multiple settings shows that when tuberculosis care is shifted out of distant clinics and into neighbourhoods and households, access expands with potential to close the current gaps in TB detection, treatment outcomes and prevention that benefit communities and families, including their children.