More than half of South Africa’s tuberculosis patients are struggling to cope with the costs related to their illnesses, with thousands of them sinking ever deeper into poverty, according to new research commissioned by the National Department of Health (NDoH).
The findings show that financial barriers that impede their ability to travel to clinics to collect test results and medication, all of which pose a challenge to the government’s plans for combating the disease and reduce cases by 80% by 2030, reports BusinessLIVE.
SA has one of the world’s worst TB epidemics, thanks to its high HIV burden. An estimated 280 000 people contracted TB and 54 200 died of the disease in SA in 2022.
“TB is not just a health issue but an economic and social catastrophe, causing financial ruin for many households,” said Aurum Institute health economist Don Mudzengi, who presented the findings of SA’s first national patient cost survey at a virtual event hosted by the department of health last week.
It found 56.2% of TB-affected households faced catastrophic related expenses, defined as being more than 20% of the household’s pre-TB annual income. Patients faced direct costs for medical consultations, transport, special foods and vitamins, and indirect costs such as lost wages. Some patients consulted private healthcare practitioners and traditional healers before receiving a TB diagnosis.
The 2020 survey included 1 130 patients from 68 health facilities, who were interviewed in their homes due to the disruption caused by Covid-19. Many faced long waits for diagnosis: the mean time to diagnosis for patients with drug-susceptible TB (DSTB) was 106 days after their symptoms began.
Most of the patients were from households already living below the poverty line before they became ill, with limited assets to draw on. Only a fifth of patients said they had savings or loans available or had sold items to shore up their household income.
TB patients' mean income plunged 44.9%, from R1 676 before symptoms to R924 at the time of the interview. Only a third of the respondents said they had obtained social assistance, despite them being eligible for temporary disability grants and the social relief of distress grant.
The survey found high levels of job losses, food insecurity and social exclusion. Almost a fifth (18%) of patients with drug-susceptible TB and more than a quarter (27%) of those with drug-resistant TB (DRTB) reported job losses.
Almost a third (29%) of DSTB patients and almost half (49%) of DRTB patients experienced food insecurity, while just more than a quarter (26%) of DSTB patients and more than half (51%) of DRTB patients reported social exclusion.
The Health Department’s Lindiwe Mvusi said TB screening needed to improve so that patients were diagnosed sooner, while reducing treatment from six to four months would also help cut clinic visits. “We should also consider delivering medicines closer to people’s homes,” she added.
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