Table 2.

Examples of main cost categories and possible interventions that might be considered to eliminate costs or mitigate impact of costs.

Cost Category	Possible Changes in Service Delivery	TB Patient Social Support and Social Protection Schemes
Direct medical: before TB diagnosis	Streamline the TB patient pathway: Understand and adapt to treatment-seeking behaviors Update and promote the national standard of TB diagnosis and eliminate irrational testing Extend access to rapid molecular diagnostics Effectively use of chest radiography Improve links with private sector providers using consistent policies (e.g., quality of care, free of charge) Intensify targeted case finding, including systematic screening for priority risk groups	Reduce/subsidize/eliminate out-of-pocket payments (OOPs): Increase insurance coverage (general) Reimburse OOP made by TB patients Regulate and eliminate informal fees Engage relevant actors in or outside TB to identify opportunities that can enable better access
Direct medical: after TB diagnosis	Expand free-of-charge or highly subsidized TB service package including TB medicines, ancillary drugs, monitoring of adverse events, preventive treatment: Promote integrated management of comorbidities and risk factors (HIV, diabetes, other lung diseases, tobacco smoking, harmful use of alcohol): Improve the quality of TB care: Update and promote the national standard of TB care with an emphasis on people-centered care Eliminate irrational treatment, hospitalization and testing	Reduce/subsidize/eliminate OOP: Increase insurance coverage for TB-related services Increase insurance coverage for relevant comorbidities and risk factors Regulate and eliminate informal fees Improve provider payment mechanism to avoid over-provision of services Explore social protection available for specific vulnerable groups and people with medical conditions
Direct non-medical	Advocate local health-seeking and for care models bringing services close to patients, including community- and workplace-based care: Improve the quality of nutritional advice and regulate irrational nutritional recommendations by health care providers (e.g., supplements)	Provide assistance via TB program: Cash transfer Specific allowances (e.g., food, transportation, etc.) by cash, voucher, or in-kind Expand the use of general social assistance schemes: Engage NGOs, civil society organizations and patient groups to ensure patient support suitable for the locality
Indirect costs (income loss)	Range of interventions to enable earlier diagnosis and patient-centered care delivery that minimize time spent seeking and receiving care (decentralization, shorter waiting times, fewer health care visits, avoid unnecessary hospitalization, etc.): Improve access to social services: Improve health workers’ knowledge on social protection schemes Seamless link between health and social offices (one-stop site) Engage civil society and community organizations and volunteers in non-health sectors (social work, charity, legal services, and volunteers)	Facilitate enrolment of eligible patients/households in existing social protection schemes: Social assistance for poor and vulnerable families Sickness/disability grant Cash or in-kind transfer program Advocate review and/or improvement of social insurance as income replacement during illness Legislate and/or enforce provisions related to social, economic, and labor rights to protect individuals during TB illness and care

Source: World Health Organization. Tuberculosis patient cost surveys: A handbook. 2017. Geneva, Switzerland: World Health Organization.