The cost of providing tuberculosis services in India from a health systems’ perspective
The End tuberculosis (TB) Strategy will require considerable investment in TB services and interventions. Current resourcing for TB is highly constrained and so, there is need to improve the allocation of resources both to and within TB programmes.
Global and national funders are increasingly demanding sound investment cases before they allocate resources to such programs. And as new technologies increasingly become available, it is critical that TB programmes have the means to justify the purchase of cost-effective technologies to their core funders.
There is therefore clearly a need to do economic analysis to support increased investment in TB which remains in its infancy in a country like India.
To estimate the costs of TB services to enable India’s TB programme and their funders allocate their resources, both to and within TB, in an efficient and fair manner.
To achieve this aim, we have defined three specific objectives:
- To provide a comprehensive set of unit costs for TB services in India
- To develop a sustainable framework (in terms of tools and processes) for TB cost data collection at the country level
- To facilitate the estimation of technical efficiency of TB services
Data collected through this exercise will take a health provider perspective. This will include costs incurred by the Ministry of Health, devolved government agencies, and private facilities. It will also cover the costs of services provided by others (such as social care) if these benefits are a core part of the TB package. Resource use will be measured using both top-down and bottom-up methods wherever possible, to allow for comparison. A bottom-up costing methodology will be prioritized where both methodologies are not possible. Cost data collection will be retrospective, over a one-year period to minimize the risk of bias due to seasonality.
The study was conducted in one of the hospitals in Pune, Maharashtra in October 2018. Data collection is also complete in 20 health facilities in Pune and Madurai.