Abstract We present a case of an international labour migrant worker from India who acquired multiple-drug resistant tuberculosis (MDR-TB) as a result of poor treatment compliance throughout his work and travel history. The travel to Sri Lanka was made under the resident visa scheme. Currently there are no mandatory health assessment requirements for inbound migrants such as resident visa holders to Sri Lanka. The diagnosis of MDR-TB was made at a district level chest clinic and the National Tuberculosis Program (NTP). This is the first documented case of MDR-TB in a foreign born migrant worker in Sri Lanka. The volume of resident visa applicants and foreign migrant workers to Sri Lanka from high TB burden countries has increased dramatically over the past five years. We examine the rationale and public health impact for undertaking a health assessment of the growing numbers inbound migrant workers to Sri Lanka from high TB burden countries.