The Cost of Scaling Up TB Services in Indonesia
Indonesia has made great strides in expanding Tuberculosis (TB) control over the last few years, with significant assistance from donors, such as the Global Fund against Acquired Immune Deficiency Syndrome (AIDS), TB and Malaria (GFATM) and the United States Agency for International Development (USAID). While there are presently substantial external funds for the Human Immunodeficiency Virus (HIV)/AIDS, TB and Malaria health programs, these are likely to diminish greatly over the coming years. The government is developing an exit strategy which aims to eliminate dependency on these grants and which focuses on increasing government budget allocations, generating revenue from insurance and corporate social responsibility financing, and improving cost-effectiveness and efficiency.
Projections of service delivery costs at both national and sub-national levels are essential for this strategy to be successful. To develop such cost projections for TB services a tool was developed and was used in Central Java, a province with around 32 million people. The data collected was then used to estimate the costs for the whole country.
The results indicate that the approximate cost of the resources needed for the country to reach its targets of treating 364,963 TB cases and 1,692 Multi-Drug Resistant Tuberculosis (MDR-TB) cases in 2014 would be USD 100 million and this figure would rise to $118 million (excluding inflation) in 2016 as the targets increase.
Based on the above figures the average cost per TB case treated in 2014 would be USD 228 and the average cost for an MDR-TB patient who starts treatment in 2014 would be USD 10,027. The average cost per capita would be 41 US cents which can be compared with the economic burden of TB in Indonesia, which is around USD 8 per capita, indicating that investment in TB detection and treatment is worthwhile.
The costs are based largely on the use of standard prices, as well as some budget figures that were obtained from a small sample of districts and facilities in Central Java. They represent the estimated operating resources required to provide good quality services. They only cover service delivery and district management costs including indirect costs, and do not include any additional costs related to TB/HIV. The costs provided by this study are probably underestimates of the total resources required to achieve the National Tuberculosis Control Program’s (NTP) treatment targets. However, those targets are quite ambitious, especially for MDR-TB, and from that respect the costs could be overestimates. Due to these factors and the small sample of districts and facilities that was used for a few of the costs the results should, be regarded as indicative and more suited for policy and planning purposes rather than for detailed budgeting.