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.
Read the id21 Research Highlight: TB diagnosis for Malawi's poor: are
free services affordable?
Bulletin of the World Health Organization (2007) 85 (8) 580-587
Can Malawi’s poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe