The Economic Case for Investing in TB in Indonesia

The Economic Case for Investing in TB in Indonesia

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

To evaluate the feasibility of these options, MSH’s technical experts are helping the Ministry identify and calculate costs associated with different TB services and programs. Innovative assessment tools and strategies have also allowed MSH to estimate the financial burden that TB places on Indonesia’s families, government, and economy. This information is being used to assist the TB control program to improve planning and to advocate for increased funding.

In Indonesia, there are an estimated 443,000 cases of active TB per year; about 25 percent of these active TB cases (over 110,000 individuals) remain undetected. In addition, over 6,000 Indonesians have multidrug resistant TB and many of these also remain undetected at the present time.

MSH’s financial analyses indicate that:

  • The cost to a family and society, including lost earnings, can be as much as $10,000 for an untreated adult TB case and $15,000 for an untreated multidrug resistant case.
  • Detecting and treating TB costs the health system and the family roughly $500 per TB case, and $5,000 per multidrug resistant TB case.
  • The data support a rationale for investment in TB prevention as a means to reduce the high cost of TB to health services and families and to society as a whole.

The NTP and MSH have shared these findings with partners and stakeholders in Indonesia as well as with international health and leadership professionals at global conferences. Indonesian officials and partners are using the data to inform policy decisions, such as on how best to increase funding for the program through the proposed national social health insurance package and through increased government budget allocations.

David Collins, MA, FCA, is a technical advisor on health finance at MSH.