Tuberculosis patient cost surveys: a handbook

Overview

This handbook builds on lessons learned from surveys implemented 2015-2017 and advice provided by the Global task force on TB patient cost surveys. It provides a standardized methodology for conducting health facility-based cross-sectional surveys to assess the direct and indirect costs incurred by TB patients and their households. In addition, it provides recommendations on results dissemination, engaging across sectors in policy dialogue and enabling action and related research for effective modifications in care delivery models, in patient support, and wider cross-sectoral interventions.

These surveys have two primary objectives:

• To document the magnitude and main drivers of different types of costs incurred by TB patients (and their households), in order to guide policies to reduce financial barriers to accessing care and minimize the adverse socioeconomic impact of TB.
• To determine the baseline and periodically measure the percentage of TB patients (and their households) treated in the national TB programme (NTP) network who incur catastrophic total costs due to TB. This information is needed to monitor progress towards one of the three high-level indicators of the End TB Strategy for which targets and milestones have been set.

To inform policy and practices for improved social protection of TB patients and affected households, and to reach the 2020 End TB Strategy target that no TB patient or their household should face "catastrophic total costs" due to TB, WHO is supporting countries to design, implement, analyze and translate into policy recommendations TB patient cost surveys.

In 2015, the WHO Global TB Programme convened a Global task force on TB patient cost surveys and developed a  field-testing protocol and survey instrument for the conduct of nationally-representative, health-facility-based surveys. The latter were used and evaluated in 10 countries ahead of a second Task Force meeting in 2017, where the survey methodology was reviewed and revised.

National TB Programmes and partners involved in supporting TB programme planning, implementation, evaluation and associated operational research.

WHO envisages that the Handbook will be put to use in all high TB burden countries ahead of 2020 and be used alongside other surveillance, monitoring and evaluation, and operational research tools to improve TB care and prevention and to end the epidemic.