BACKGROUND: The Democratic Republic of Congo´s free TB care policy and recent progress with universal health coverage are insufficient to remove barriers to TB care access and adherence. As there were no nationally representative data on the economic burden borne by TB
patients, the TB programme conducted a national survey to assess the proportion of TB patients facing catastrophic costs, which could also serve as a baseline for monitoring progress.
METHODS: A national survey with retrospective data collection and projection, following WHO methods,
was administered to 1,118 patients in 43 treatment zones. Each patient was interviewed once on costs, time loss, coping measures, income, household expenditure and asset ownership. Total costs were expressed as a percentage of annual household expenditure.
RESULTS: In 2019, 56.5%
of households affected by TB experienced costs above 20% of their annual household expenditure. Mean costs amounted to respectively US$400 (range: 328 471) and US$1,224 (range: 762 1,686) per episode of first-line and drug-resistant TB. The risk of catastrophic costs
increased with hospitalisation, drug resistance status and lower economic status. Half of households resorted to coping strategies and experienced food insecurity. Only 7.5% received social support.
CONCLUSION: TB-affected households incur on average a cost of US$549, despite
free TB care policy. Mitigating this burden with medical cost reductions, social and labour market measures will be key.
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Document Type: Research Article
Programme National de Lutte contre la Tuberculose, Ministére de la Santé Publique, Kinshasa, DR Congo, Service de Microbiologie, Département de Biologie médicale, Université de Kinshasa, Kinshasa, DR Congo
World Health Organization, DR Congo Office, Kinshasa, DR Congo
Institut National de Statistique, Ministère du Plan, Kinshasa, DR Congo
Programme National des Comptes Nationaux de la Santé, Ministère de la Santé Publique, Kinshasa, DR Congo
Health Economics Research Unit, Kenya Medical Research Institute – Wellcome Trust Research Programme, Nairobi, Kenya
Global TB Programme, World Health Organization, Geneva, Switzerland
01 November 2021
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