Hidden cost of TB treatment

Medical costs for treating the disease is negligible compared to other expensives that force patients to fall behind and refuse to go to hospital

Martha Njoki does not like to talk about the pain she went through seeking treatment for her 12-year-old daughter who had Multi-Drug Resistant Tuberculosis (MDR-TB).

Within eight months, she had spent Sh3 million and still her child succumbed to the disease.

Other victims of TB share a similar storyline.

For Joyce Wangechi, she was detained at Kenyatta National Hospital for three months after failing to raise Sh1.2 million. Before coming to Kenyatta she had shuttled between eight health facilities seeking treatment for the disease.

Renowned music DJ, Eliud Chichi, 42, a survivor of MDR-TB has spent an estimated Sh5 million on treatment since 1995. He was one of the first 14 MDR-TB patients to be put on a treatment programme in 2008.

           Fall behind

In a country where TB treatment is free, one would expect to hear nothing, but rosy stories from victims. However, the hidden cost of treating the disease has seen many patients fall behind.

The first national TB patient cost survey unveiled last week shows that one person with Drug Resistant TB (DR-TB) spends at least Sh145,109 during treatment, whereas those with Drug Sensitive TB incur an estimated Sh25,874. This includes direct and indirect costs.

Some of those hidden costs – according to experts and Ministry officials – such as medical, nutrition and transport are associated with seeking and receiving healthcare, and are also related to loss of income.

“Even though TB diagnosis and treatment is free, hidden costs incurred by patients and their households may worsen poverty and health. Such costs make TB patients less likely to present for care, complete TB testing, and initiate and adhere to treatment,” Health Cabinet Secretary Sicily Kariuki said.

She said the costs place an economic burden on households, worsening poverty and increasing deaths due to the disease.

The results of the survey showed that TB patients and their households incur high costs and a high economic burden due to TB disease.

Some of the main cost drivers according to the 1,353 eligible TB patients interviewed randomly in selected health facilities in 32 counties, are costs related to direct non-medical costs such as food and travel. Kariuki said through a statement read by Director of Medical Services, Jackson Kioko that the costs could be reduced through social protection while medical insurance and improved models of TB care, can help mitigate the direct medical and indirect costs.

Over half of the patients in the survey were malnourished with 53.5 per cent of households experiencing food insecurity due to TB. Out of the 1,353 patients interviewed, an estimated 1,071 were identified with Drug Sensitive TB, while 282 had been diagnosed with DR-TB.

                Lost job

The survey conducted between June 2016 and January 2017 established that households affected by TB incurred severe socio-economic consequences. An estimated 62.5 per cent of them had lost jobs due to TB where in 9.3 per cent of households’ children disrupted school learning process and 36 per cent experienced social exclusion. Meanwhile, 27.8 per cent used coping strategies such as loans, sale of assets or savings.

“Some of the costs incurred by TB patients are prohibitive and the patients need to be cushioned against these costs,” Enos Masini, World Health Organisation (WHO) Kenya TB and Malaria Coordinator said.

He urged Kenya to increase its domestic investment in TB in order to eradicate the disease.

Masini said reliance on foreign donors to fund the TB campaign is not sustainable in the long run.

“In the past, TB drugs were provided by foreign donors, but now increasingly the government is catering for medication. In order to build on the momentum, we are asking Kenya to scale up domestic resources for TB,” Masini said during the launch of the study, which is in line with the WHO strategy to end TB by 2035.

According to WHO, Kenya is among the 30 high-burden countries which together contribute 85 per cent of all TB global cases.

         Minimise cost

Masini said one of the gaps in Kenya’s health system is that close to 50 per cent of all people who fall sick with TB are neither diagnosed nor treated.

As part of the government effort to reduce the cost of seeking health care, the government is in the process of scaling up health insurance enrolment. 

The health insurance subsidy programme that include the medical cover for the elderly and people with disabilities and the removal of user fees in the public primary healthcare facilities will ease the cost of seeking healthcare.

“There is need, therefore, to develop policies and laws that aim at eliminating the discrimination in workplace of people with TB disease and ensure job security during and after treatment. This will minimise loss of income during TB treatment and ensure children’s schooling in not interrupted,” said Kariuki.

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