Assessing access barriers to tuberculosis care with the Tool to Estimate Patients' Costs: pilot results from two districts in Kenya

Abstract

BackgroundThe poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.MethodsThe Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.ResultsA total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.ConclusionsThe Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.

Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso

“…[10][11][12] The alternative threshold used in the present study (10% of the total annual income of the patient's household) was chosen as a better reflection of the financial pressures that may exist in low-income households in rural communities. 9,13,14 In the present study, we systematically explored those medical and non-medical out-of-pocket expenses 15,16 that resulted from apparent failures to follow the national policy for tuberculosis care. These failures included policy gaps resulting in extra services that were justified but not covered by the free-of-charge strategy, and health-system inadequacies that led to unjustified services, poor patient management and poor health-care delivery.…”

Socio-demographic factors affecting knowledge level of Tuberculosis patients in Rajshahi City, Bangladesh

“…In Bangladesh, women tend to have longer diagnostic and treatment delays compared to men 8 . Lack of TB knowledge has been shown to be associated with diagnostic delay and in some case it is associated with poverty [9][10][11][12] . Bangladesh is considered to be a low human development country based on the value of Human Development Index (HDI=0.500), placed 146 out of 187 countries and territories 13 .…”

Inequidades geográficas y tuberculosis en Costa Rica, 2008-2012

“…En Kenia, se estudiaron las barreras geográficas y socioeconómica con el fin de incidir en la adherencia al tratamiento para el control de la epidemia (Mauch et al, 2011). En China, las mujeres tienen casi dos veces más probabilidad de enfermar respecto a los hombres (Chen et al, 2014).…”

“…Se utiliza el concepto de vulnerabilidad social para enfocarse en ciertos grupos de personas, como la etnia, la condición socioeconómica (Pasipanodya et al, 2012), o que tienen modos de vida en sus espacios laborales y domésticos que favorecen la transmisión de la enfermedad y dificultan el acceso a la atención (Goldberg, 2012). El comportamiento espacial de la morbilidad y la mortalidad de las enfermedades respiratorias se ha asociado también con la contaminación ambiental y la privación material en el caso de la Enfermedad Pulmonar Obstructiva Crónica (EPOC) (Chan, Chian, Ming Daw, Hsuan-wen, y Shi-yung Liu, 2014) Las barreras geográficas y socioeconómicas para el acceso al tratamiento determina la prevalencia de la tuberculosis en primer lugar, pero también nuevos casos y su letalidad (Mauch et al, 2011). El estudio del comportamiento geográfico de la enfermedad se ha considerado fundamental para orientar la vigilancia epidemiológica y el control del riesgo en Estados Unidos (Penman Aguilar, McDavid, y Hazel, 2013).…”