Comparison of incidence of catastrophic health expenditure among tuberculosis patients in public and private health facilities in Kaduna State, North-Western Nigeria, 2016

Abstract

Background: Despite providing free tuberculosis (TB) diagnosis and treatment services, TB patients still incur financial hardship while seeking for care. Involving private health facilities through Public-Private Mix (PPM) has been identified by World Health Organization as a strategy for eliminating catastrophic health expenditure (CHE) due to TB. However, studies which compares the incidence of CHE in public and private health facilities in Nigeria in order examine the extent to which PPM reduces CHE are scarce. We therefore compared the incidence of CHE due to TB among patients in public and private health facilities rendering TB Directly Observed Treatment Short-course (DOTS) services in Kaduna State, North-Western Nigeria. Methods & Materials: We conducted a comparative longitudinal study in 2016, recruiting 274 pulmonary TB patients, 137 from public health facilities and 137 from private health facilities using a multi-stage sampling technique. Data was collected using a questionnaire adapted from a tool developed by USAID and was analysed using SPSS version 23.0 software. CHE was measured using a threshold of out of pocket (OOP) health expenditure > 40% of non-food expenditure. Bi-variate and multi-variate analysis were conducted to identify risk factors by estimating the adjusted odds ratio (AOR) and 95% confidence interval (CI). Results: The average cost per TB patient successfully treated from the patient's perspective was lower in public health facilities (US$ 262.9) than in private health facilities (US$ 485.7) (t = -2.79; p = 0.006). However, after controlling for the effect of possible confounders, the incidence of CHE due to TB was higher in public health facilities (21.20%) than in private health facilities (13.10%) (AOR = 2.87; 95% CI, 1.22–6.73). Conclusion: The incidence of CHE due to TB was higher in public health facilities compared to private health facilities. We recommend that efforts to reduce OOP expenditure (e.g. community management of TB) among TB patients in public health facilities should be explored as well as expanding the PPM DOTS services in Kaduna State.