Table 4. Suggested recommendations to improve coverage, predictability and impact of CCTs in Zimbabwe.

Challenge	Recommendation
Suboptimal coverage	Revise DR-TB registers to capture data on CCT (registration status and receipt). Sensitise health care workers on availability and importance of registering people on CCT. Engage social workers to assess welfare of people on DR-TB treatment. Implement electronic health records to track coverage and access to CCT in real or near real-time.
Delays, inconsistent disbursements and suboptimal size of transfer	Decentralise CCT disbursements to district level where patients are seen monthly to reduce administrative delays and facilitate earlier and more consistent disbursements. Replace the current system of confirming that somebody is still on treatment by making “disbursing CCT” the default option once the expected treatment duration is determined. This will require periodic monitoring to remove people who die or are LTFU from payment runs. Introduce fixed dates of CCT disbursements to ensure predictability and consistency. Implement account verification procedures at the time of registration to minimise the number of rejected returns. Increase the size of the CCT to match the costs and income loss that is experienced by households affected by DR-TB.
Mitigate socioeconomic effects of post treatment morbidity and income loss	Extend CCT to cover post-treatment period. Enhance multisectoral approaches beyond the Ministry of Health and Child Care.