Abstract
Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.
Highlights
Tuberculosis (TB) remains a major global public health problem
Submission of Collection Review articles is by invitation only, and they are only published as part of a PLOS Collection as agreed in advance by the PLOS Medicine Editors
The post-2015 Global TB Strategy includes two epidemiological targets: a 95% reduction in deaths caused by tuberculosis and a 90% reduction in the tuberculosis incidence rate between 2015 and 2035
Summary
Service Quality Indicators Standardized TB recording and reporting systems generate, when used correctly, solid direct measurements of the quality of TB diagnosis and treatment, through patient-based laboratory and treatment registers. A growing number of national population-based surveys of TB prevalence have been conducted, to better measure the disease burden caused by TB and to help monitor progress towards the epidemiological impact targets [53] These surveys can provide direct (though cross-sectional) data on coverage of TB services and provide invaluable information about access, health seeking behaviour, and health care utilization, disaggregated by socioeconomic status demographic factors. It provides options for measurement approaches and guides country adaptation of the generic survey instrument [58] This tool-kit was primarily intended to be a ‘‘diagnostic’’ tool, which should help countries identify the main cost drivers and thereby inform policy decisions on how to reduce patient costs and related access barriers.
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