Making TB services more affordable in Malawi

Can Malawi’s poor afford free tuberculosis services?
Patient and household costs associated with a tuberculosis diagnosis in Lilongwe

This paper in the Bulletin of the World Health Organization assesses the relative costs of accessing a tuberculosis (TB) diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within six kilometres and provided free of charge. The paper assesses patient and household direct and opportunity costs from a survey of 179 TB patients.

It finds that on average, patients spent US$ 13 (18 days income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129 per cent of total monthly income. For the poor, this cost rose to 248 per cent of monthly income. When a woman or when the poor are sick, the opportunity costs faced by their households are greater.

The paper concludes that patient and household costs of TB diagnosis are prohibitively high even where services are provided free of charge. In scaling up TB services to reach the Millennium Development Goals, there is an urgent need to identify strategies for diagnosing TB that are cost-effective for the poor and their households. [adapted from authors]
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