More than half of South Africa’s tuberculosis (TB) patients face catastrophic costs, plunging their households deeper into poverty, according to new research commissioned by the Health Department. The findings highlight significant financial barriers that impede patients’ access to clinics for test results and medication. These barriers challenge the government’s ambitious plans to reduce TB cases by 80% by 2030.
South Africa grapples with one of the world’s most severe TB epidemics, exacerbated by its high HIV burden. In 2022, an estimated 280,000 people contracted TB, and 54,200 died from the disease, according to the World Health Organisation (WHO).
Don Mudzengi, a health economist at the Aurum Institute, said TB is not just a health issue but an economic and social catastrophe, causing financial ruin for many households. He presented the findings of South Africa’s first national patient cost survey at an event hosted by the Department of Health.
The survey revealed that 56.2% of TB-affected households faced catastrophic expenses, defined as exceeding 20% of the household’s pre-TB annual income. Patients incurred direct costs such as medical consultations, transport, special foods, and vitamins, and indirect costs such as lost wages for patients and caregivers. Some patients consulted private healthcare practitioners and traditional healers before receiving a TB diagnosis.
In 2020, the survey included 1,130 patients from 68 health facilities interviewed in their homes due to disruptions caused by the Covid-19 pandemic. Many patients experienced long delays in getting a diagnosis, with the mean time to diagnosis for drug-susceptible TB (DSTB) patients being three-and-a-half months (106 days) after symptom onset. Most patients were from households already living below the poverty line before falling ill, with limited assets to draw upon.
Only a fifth of patients reported having savings or loans or selling items to support their household income. The mean income of TB patients dropped by 44.9%, from R1,676 before symptoms to R924 at the time of the interview. Despite eligibility for temporary disability grants and social relief distress grants, only a third of respondents had received social assistance.
Mudzengi said once TB strikes, jobs are lost, incomes fall, and there is little to no support to manage the costs. The lack of social assistance compounds the problem. The survey found high levels of job losses, food insecurity, and social exclusion among TB patients.
Almost a fifth (18%) of drug-susceptible TB patients and over a quarter (27%) of drug-resistant TB (DRTB) patients reported job losses. Nearly a third (29%) of DSTB patients and almost half (49%) of DRTB patients experienced food insecurity. Just over a quarter (26%) of DSTB patients and more than half (51%) of DRTB patients reported social exclusion.
Using a WHO-devised methodology for international comparisons, South Africa ranked in the middle among countries conducting these surveys, with its patients faring similarly to those in Burkina Faso and the Democratic Republic of Congo.
Lindiwe Mvusi from the Health Department emphasised the need for improved TB screening to ensure earlier diagnosis. She also suggested that reducing treatment duration from six to four months could decrease clinic visits and proposed delivering medicines closer to patients’ homes.