TDR and the Global Tuberculosis Programme of the World Health Organization (WHO) are supporting countries in West and Central Africa to investigate the costs faced by patients and households affected by tuberculosis (TB).
Patients with TB often incur large costs related to illness and disability. These include medical and non-medical costs associated with seeking and receiving health care, and costs related to loss of income. Such costs can create access barriers to TB services and increase the risk of disease transmission. They also place an economic burden on households, which can push people below the poverty line or deeper into poverty.
This is why one of the 3 targets of WHO’s End TB Strategy calls for no TB patients or their households to face “catastrophic costs” due to TB by 2020, in line with efforts towards achieving universal health coverage and social protection.
The political declaration of the first-ever UN High Level Meeting on TB, which brought together Heads of State and other leaders in September 2018, also recognizes the often catastrophic, economic and social impacts and burden of TB for people affected by the disease, their households, and affected communities, and calls for actions to reduce these impacts, especially among the most vulnerable.
“Tuberculosis mostly affects poor people, so it is critical that we better understand and address the financial and economic barriers they face for being diagnosed or being appropriately treated,” says Dr Jean-Pierre Baptiste, WHO representative in Benin. Some patients lose their jobs or are expelled from their families because of the stigma and discrimination associated with the illness, and other patients cannot continue to work and get treatment at the same time because of the need to go to the treatment centre on a regular basis. They are then at risk of not having enough money for food and other expenditures.
Bringing together 26 countries from West and Central Africa to find solutions
Dr Baptiste hosted a recent regional workshop, jointly organized by TDR and the WHO Global TB Programme in Benin, to begin to address these issues. The work is being done in collaboration with the WHO Regional Office for Africa, and the secretariat of the West African and Central African regional networks for TB control (WARN-TB and CARN-TB). The Global Fund to Fight AIDS, Tuberculosis and Malaria also supported the country representatives to join the workshop.
Participants from 24 countries developed protocols for national surveys and data collection tools on TB patient costs, in line with the methodology developed by the WHO Global TB Programme and outlined in the Tuberculosis Patient Cost Surveys: A Handbook.
“This regional workshop is a fantastic opportunity given to all our national TB programmes,” said Professor Dissou Affolabi from the executive secretariat of the WARN-TB & CARN-TB. “Countries should take the opportunity of using these standardized tools developed by WHO’s Global TB Programme. They will help us determine for all West and Central Africa countries the magnitude and type of costs incurred by TB patients in the region.”
The workshop was conducted in English, French and Portuguese and provided a combination of lectures and practical sessions. Nigeria and Ghana, which had already conducted national TB patient cost surveys, shared their experiences. The others left the workshop with draft survey protocols and data collection tools to conduct their own surveys.
TDR scientist Corinne Merle, who is coordinating the WARN and CARN-TB networks, said, “These surveys are critical for the countries. They will inform the basis of implementation research projects examining how to reduce the direct and indirect costs of care faced by these patients. Although many countries are far from attaining universal health coverage and social protection, all countries can take steps in this direction, and this workshop is one of those steps”. The countries who attended the workshop in Benin will benefit from additional research support from TDR through the WARN-TB and CARN-TB networks.
Dr Nobuyuki Nishikiori from the Global TB Programme added, “The ultimate goal of the survey is to improve TB care in line with countries’ efforts towards universal health coverage and social protection. The survey will also inform policy discussions among relevant multi-sectoral partners, especially those in the poverty reduction, social protection, and labour sectors. We believe the workshop provided an important step for countries to move towards stronger national responses to TB.”
The Global TB Programme is responsible for global guidance on the design, implementation, analysis and reporting of national TB patient cost surveys, and is also coordinating the provision of technical assistance to countries implementing such surveys.
For more information regarding WARN-TB and CARN-TB networks activities, contact Corinne Merle.
For guidance on patient cost surveys and coordination of technical assistance, contact Nobu Nishikiori and/or Inés Garcia Baena.