Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe
OBJECTIVE: To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometres and provided free of charge. METHODS: Patient and household direct and opportunity costs were assessed f...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The World Health Organization
|
| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000800009&lng=en&tlng=en |
| _version_ | 1797282091026612224 |
|---|---|
| author | Julia R Kemp Gillian Mann Bertha Nhlema Simwaka Felix ML Salaniponi Stephen Bertel Squire |
| author_facet | Julia R Kemp Gillian Mann Bertha Nhlema Simwaka Felix ML Salaniponi Stephen Bertel Squire |
| author_sort | Julia R Kemp |
| collection | DOAJ |
| description | OBJECTIVE: To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometres and provided free of charge. METHODS: Patient and household direct and opportunity costs were assessed from a survey of 179 TB patients, systematically sampled from all public and mission health facilities in Lilongwe. Poverty status was determined from the 1998 Malawi Integrated Household Survey (MIHS). FINDINGS: On average, patients spent US$ 13 (MK 996 or 18 days' income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures. For the poor, this cost rose to 248% of monthly income or 574% after food. When a woman or when the poor are sick, the opportunity costs faced by their households are greater. CONCLUSION: 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. |
| first_indexed | 2024-03-07T17:06:56Z |
| format | Article |
| id | doaj.art-85b48b5fa9da4071b8e8823c8dd07f56 |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:06:56Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-85b48b5fa9da4071b8e8823c8dd07f562024-03-03T02:31:43ZengThe World Health OrganizationBulletin of the World Health Organization0042-968685858058510.1590/S0042-96862007000800009S0042-96862007000800009Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in LilongweJulia R Kemp0Gillian Mann1Bertha Nhlema Simwaka2Felix ML Salaniponi3Stephen Bertel Squire4Equi-TB Knowledge ProgrammeLiverpool School of Tropical MedicineREACH TrustNational TB ProgrammeLiverpool School of Tropical MedicineOBJECTIVE: To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometres and provided free of charge. METHODS: Patient and household direct and opportunity costs were assessed from a survey of 179 TB patients, systematically sampled from all public and mission health facilities in Lilongwe. Poverty status was determined from the 1998 Malawi Integrated Household Survey (MIHS). FINDINGS: On average, patients spent US$ 13 (MK 996 or 18 days' income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures. For the poor, this cost rose to 248% of monthly income or 574% after food. When a woman or when the poor are sick, the opportunity costs faced by their households are greater. CONCLUSION: 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.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000800009&lng=en&tlng=en |
| spellingShingle | Julia R Kemp Gillian Mann Bertha Nhlema Simwaka Felix ML Salaniponi Stephen Bertel Squire Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe Bulletin of the World Health Organization |
| title | Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe |
| title_full | Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe |
| title_fullStr | Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe |
| title_full_unstemmed | Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe |
| title_short | Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe |
| title_sort | can malawi s poor afford free tuberculosis services patient and household costs associated with a tuberculosis diagnosis in lilongwe |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000800009&lng=en&tlng=en |
| work_keys_str_mv | AT juliarkemp canmalawispooraffordfreetuberculosisservicespatientandhouseholdcostsassociatedwithatuberculosisdiagnosisinlilongwe AT gillianmann canmalawispooraffordfreetuberculosisservicespatientandhouseholdcostsassociatedwithatuberculosisdiagnosisinlilongwe AT berthanhlemasimwaka canmalawispooraffordfreetuberculosisservicespatientandhouseholdcostsassociatedwithatuberculosisdiagnosisinlilongwe AT felixmlsalaniponi canmalawispooraffordfreetuberculosisservicespatientandhouseholdcostsassociatedwithatuberculosisdiagnosisinlilongwe AT stephenbertelsquire canmalawispooraffordfreetuberculosisservicespatientandhouseholdcostsassociatedwithatuberculosisdiagnosisinlilongwe |