Eliminating catastrophic costs due to TB

Policy impact of findings from Ghana’s national survey of costs faced by TB patients and their households.

One of the three targets of the End TB Strategy is that no TB patients or their households should face “catastrophic total costs” due to TB, in line with policy efforts related to progress towards achieving universal health coverage (UHC), and the Sustainable Development Goals (SDGs). The inclusion of the indicator on catastrophic costs is new, reflecting the importance of alleviating the heavy financial burden of TB care as a key component to global TB elimination. To measure this indicator, countries are carrying out nationally representative TB patient cost surveys, which determine the proportion of TB patients who spend 20% or more of their household annual income on their TB diagnosis and care.

TB Centre member and LSHTM staff Debora Pedrazzoli (under the supervision of Delia Boccia Rein Houben and Jo Borghi) has been working with the National Tuberculosis Programme (NTP) of the Ministry of Health of Ghana to conduct a nationally-representative health facility-based survey in 2016-2017 to assess the magnitude and main drivers of costs incurred by TB patients in Ghana. The survey, the first to be conducted in sub-Saharan Africa, found that TB patients lack financial protection, with more than two-thirds of TB-affected households facing financial catastrophe, and that payments for TB care led to a significant increase in the proportion of TB-affected households that live below the poverty line at the time of survey compared to pre-TB diagnosis.

Using the findings from this survey in policy briefings, Ghana’s NTP, with support from the Global TB Programme at WHO and LSHTM, engaged key Government of Ghana’s agencies to secure political commitment to mitigate TB patient costs through multi-sectoral action, and advocate for strong social support for TB patients and their households. During the 71th World Health Assembly, the delegate of Ghana cited the national TB patient cost survey as the evidence base for the need for a multisector response to ending TB. Ghana’s NTP will also hold a national stakeholder consultation in August 2018 to disseminate and review the survey findings, and launch a national action plan to enable policy guidance and interventions to reduce and compensate for costs faced by TB patients and their households in Ghana.

Link to publication in Tropical Medicine and International Health.

By Debora Pedrazzoli