Faculty Opinions recommendation of Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe.
This study confirms my own and many others’ beliefs that there are high costs, in terms of money needed for transport, food and lost days from work, associated with accessing a TB diagnosis. Although tuberculosis services in many resource-poor countries are provided free of charge at the point of delivery, little is known about the costs involved from a patient or household perspective in getting a diagnosis of tuberculosis. The authors conducted a cross-sectional, stratified survey to look at patient and household direct and opportunity costs associated with accessing a diagnosis of TB in the city of Lilongwe, Malawi. The routine diagnosis of TB requires at least three visits to a health facility, the number being higher if patients are found to be sputum smear-negative. On average, patients spent 18 days income or lost 22 days from work while accessing a TB diagnosis, the costs being significantly higher proportionally for poor patients compared with non-poor patients. This was a well conducted, important study showing that it is not good enough to just offer free services at the point of delivery for high-burden public health problems such as tuberculosis. Patients’ costs in accessing services can be very high, and these may be an important determinant in detection rates of TB cases in the region. TB case detection rates in many parts of sub-Saharan Africa are low, and strategies need to be explored to shorten the diagnostic pathway through a ‘one-stop’ diagnosis and also to bring diagnosis closer to where people live. This Recommendation is of an article referenced in an F1000Prime Report also written by Andrew Ramsay and Anthony D Harries.