title: Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso.
abstract: BACKGROUND
  Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access.
  
  
  METHODS
  Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs) associated with TB were collected according to the different stages of their healthcare pathway.
  
  
  RESULTS
  Median direct cost associated with TB was US$101 (n = 229) (i.e. 2.8 months of household income). Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services), 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology), 68% during the intensive treatment (i.e. medical and travel costs) and 50% during the continuation treatment (i.e. medical and travel costs). For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs.
  
  
  CONCLUSIONS
  The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a "free care" policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make "free" health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.
authors: School of Public Health, Université Libre de Bruxelles, Research Center Health Policy and Systems - International Health, Brussels, Belgium. slaokri@ulb.ac.be
authors: Samia
authors: S
authors: Laokri
authors: Maxime Koiné
authors: MK
authors: Drabo
authors: Olivier
authors: O
authors: Weil
authors: Benoît
authors: B
authors: Kafando
authors: Sary Mathurin
authors: SM
authors: Dembélé
authors: Bruno
authors: B
authors: Dujardin
mesh_terms: D000328:Adult; D002050:Burkina Faso; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics