Cost estimates and projections are essential for planning, budgeting, financing, and evaluating tuberculosis (TB) service delivery. Through the USAID-funded TB CARE I project, MSH developed the following suite of tools to help government and nongovernmental organization program managers analyze these costs.
- The TB Service Delivery Costing Tool determines and projects the cost of TB services to help allocate resources, secure financing from governments and donors, and negotiate benefit packages and reimbursement rates with insurance schemes.
- The Multidrug Resistant TB (MDR-TB) Cost-Effectiveness Analysis Tool compares the cost-effectiveness of different MDR-TB service delivery modalities to help program managers select the modalities that produce the best results at the least cost.
- The TB Economic Burden Analysis Tool estimates the cost of a country’s TB burden in terms of service delivery, patient expenses (e.g., transport), and productivity losses due to patient illness and premature death. The results are used to advocate for increased funding and support for TB control.
An important element of TB financing is protecting patients from poverty. To this end, MSH helped develop the MDR TB Patient Costing Tool a tool to identify the costs TB patients incur to get good quality care, including transport, food, and loss of income. MSH used this tool in Ethiopia and provided the results to the Ministry of Health to inform policies that help TB patients access care and maintain financial security.
MSH conducts analyses to inform TB financing strategy and system improvements. For example, in 2013, MSH analyzed the TB expenditure tracking system in Indonesia and recommended modification to strengthen the system. Also in 2013, MSH conducted an analysis to determine the challenges of financing TB treatment through Indonesia’s national health insurance scheme and used the results to help the Ministry of Health negotiate TB service delivery terms with insurance companies.
In Indonesia, MSH helped the Ministry of Health develop and facilitate an international workshop on TB financing where representatives from China, Vietnam, the Philippines, Myanmar, Malaysia, Thailand, Laos, and Indonesia presented on their countries’ TB financing systems and challenges. The shared experiences have been fed back to the countries’ governments for inclusion in their financing policies. Furthermore, MSH helped Indonesia’s Ministry of Health prepare national TB financing guidelines and is helping develop Indonesia’s 25-year national TB financing roadmap and a value-for-money analysis.