Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios
Abstract Background The World Health Organization’s End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have e...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | Infectious Diseases of Poverty |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40249-019-0519-7 |
| _version_ | 1830461848908988416 |
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| author | Ahmad Fuady Tanja A. J. Houweling Muchtaruddin Mansyur Erlina Burhan Jan Hendrik Richardus |
| author_facet | Ahmad Fuady Tanja A. J. Houweling Muchtaruddin Mansyur Erlina Burhan Jan Hendrik Richardus |
| author_sort | Ahmad Fuady |
| collection | DOAJ |
| description | Abstract Background The World Health Organization’s End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. Methods From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. Results We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients’ primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). Conclusions Indonesia’s current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TB-affected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding. |
| first_indexed | 2024-12-21T11:35:01Z |
| format | Article |
| id | doaj.art-527e212248ac4890971e25b787bf407e |
| institution | Directory Open Access Journal |
| issn | 2049-9957 |
| language | English |
| last_indexed | 2024-12-21T11:35:01Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Infectious Diseases of Poverty |
| spelling | doaj.art-527e212248ac4890971e25b787bf407e2022-12-21T19:05:27ZengBMCInfectious Diseases of Poverty2049-99572019-02-018111410.1186/s40249-019-0519-7Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenariosAhmad Fuady0Tanja A. J. Houweling1Muchtaruddin Mansyur2Erlina Burhan3Jan Hendrik Richardus4Department of Public Health, Erasmus MC, University Medical Centre RotterdamDepartment of Public Health, Erasmus MC, University Medical Centre RotterdamDepartment of Community Medicine, Faculty of Medicine, Universitas IndonesiaDepartment of Respiratory and Pulmonology, Persahabatan Hospital – Faculty of Medicine, Universitas IndonesiaDepartment of Public Health, Erasmus MC, University Medical Centre RotterdamAbstract Background The World Health Organization’s End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. Methods From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. Results We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients’ primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). Conclusions Indonesia’s current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TB-affected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding.http://link.springer.com/article/10.1186/s40249-019-0519-7TuberculosisMultidrug-resistant tuberculosisCatastrophic costSocial protectionFinancial supportCash transfer |
| spellingShingle | Ahmad Fuady Tanja A. J. Houweling Muchtaruddin Mansyur Erlina Burhan Jan Hendrik Richardus Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios Infectious Diseases of Poverty Tuberculosis Multidrug-resistant tuberculosis Catastrophic cost Social protection Financial support Cash transfer |
| title | Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios |
| title_full | Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios |
| title_fullStr | Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios |
| title_full_unstemmed | Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios |
| title_short | Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios |
| title_sort | effect of financial support on reducing the incidence of catastrophic costs among tuberculosis affected households in indonesia eight simulated scenarios |
| topic | Tuberculosis Multidrug-resistant tuberculosis Catastrophic cost Social protection Financial support Cash transfer |
| url | http://link.springer.com/article/10.1186/s40249-019-0519-7 |
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