Tuberculosis (TB) disproportionately affects
people in developing countries, where 95%
of world TB cases and 98% of world TB
deaths occurred [1]. TB causes 25% of
all preventable deaths in the developing
world [1]. The highest incidence rates are
found in Africa (259/100,000) and SouthEast
Asia (202/100,000). TB is a major
public health problem in Myanmar. In the
National Health Plan (NHP) 2006-2011, it is
ranked as the third priority disease. The
incidence among the general population was
about 171 TB patients per 100,000
populations in 2006, and the annual risk of
infection was 1.5 % [2].
TB takes a huge financial burden. Every
year 8 million peoples around the world
contracted TB and the total budgets of
National TB programme (NTPs) in high
burden countries (HBC) amount to US$ 1.8
billion in 2008, up from US$ 0.5 billion in
2002. NTP budgets for the 90 countries with
91% of global TB cases reported total US$
2.3 billion in 2008. Budgets are typically
equivalent to about US$ 100-300 per patient
treated. Funding for TB control has grown
to US$ 2.0 billion in high burden countries
and US$2.7 billion across the 90 reporting
countries [2].
When the tuberculosis cases in the world are
reviewed, 75% of those affected by TB are
men and women in their productive age
of 15 to 54 years [3]. People living in poor
and over-crowded conditions with poor
ventilation, and lacking sanitation are most
likely to contract TB. Those having TB and
171their families are more prone to fall into
poverty and suffer from the economic
consequences of the disease. Poor people
who are already malnourished and live in
environments with poor sanitation are more
susceptible to TB infection. Thus, TB and
poverty is a vicious cycle. Therefore, TB
has a significant economic and social cost to
individuals, families and countries. TB
patients lost 3-4 months work loads in
average and 20-30 percent of annual
household income [3].
In Myanmar, after many years of drug
shortages, and the sporadic provision of
drugs by WHO, UNDP and other donors, a
reliable drug supply had been ensured
through the Global Fund for AIDS, TB and
Malaria (GFATM). However, the GFATM
terminated funding support for Myanmar in
2005. The three diseases fund was
established in 2006. Although anti-TB drugs
are free of charge at public sector, TB
patients needed to pay for chest X-ray [4].
With the development of health economic
system, health care cost is considered not
only the sole responsibility of government
but also the voluntary contribution from
the community and Non-Governmental
Organizations (NGOs). The government
budget on current health expenditure is
about 14361.8 million kyats with capital
expenditure of 9816.8 million kyats,
altogether 24178.6 million kyats for health
care. The estimation of per capita health
expenditure is 4278 kyats [5].
The impact of TB is most often measured as
the direct cost of treatment to health service,
which is, the cost of medicines, person, and
facilities used. However, patients seek
costly treatment from traditional healers or
the private sector before an accurate
diagnosis is made. The costs to patients and
their families that can be quantified are
principally in the form of lost earnings from
loss of work due to illness or death.
Additional costs come from food required
while in hospital and the cost of travel to
hospital or clinic for care. The socioeconomic
burden of TB can highly
influence the defaulter rate and multi drug
resistant TB cases [6]. Thus, TB causes
enormous socio-economic disruption and
hampers the development of country.
Economic evaluation is fundamentally about
resource use and can serve an important role
in health-care decision making.
Most of the studies conducted in Myanmar
analyzed hospital cost and only a few
studies explored cost borne by individual at
households levels which was consumer cost.
According to available literature, there is no
study on economic burden of TB patients
taking treatment at public TB centers in
Myanmar after initiation of DOTS with the
exception of two studies - one explored
from social science aspects and another
study conducted with TB patients who are
under Short Course Chemotherapy (SCC)
regimen [4, 7].
In Myanmar, most of the International
NGOs plan to provide social and financial
support for TB patients in order to reduce
their economic burden. Thus, it is hoped
that this study will contribute a valuable
input for development of patient support
system and also contribute as baseline
information for planners and decisionmakers
for improvement of health care
financing system in Myanmar.
General objective
To explore economic burden of TB patients
taking treatment at Township TB Center in
North Okkalapa Township.
Specific objectives
1. To determine the socio-economic profile
of TB patients taking treatment at
Township TB Centre
2. To estimate direct and indirect costs
incurred by those TB patients before
taking anti-TB treatment and during
treatment
3. To describe economic burden of those
TB patients