Comparison of incidence of catastrophic health expenditure among tuberculosis patients in public and private health facilities in Kaduna state, Nigeria, 2016

Introduction : despite providing free tuberculosis (TB) diagnosis and treatment services, TB patients still incur financial hardship while seeking for care. Involving private health facilities through Public-Private Mix (PPM) has been identified by World Health Organization as a strategy for eliminating catastrophic health expenditure (CHE) due to TB. There is paucity of studies comparing the incidence of CHE in public and private health facilities in Nigeria. We compared the incidence of CHE due to TB among patients in public and private health facilities rendering TB Directly Observed Treatment Short-course (DOTS) services in Kaduna State. Methods : we conducted a comparative longitudinal study in 2016, recruiting 274 pulmonary TB patients, 137 from public health facilities and 137 from private health facilities using a multi-stage sampling technique. We collected data using a questionnaire adapted from a tool developed by USAID. CHE was measured using a threshold of out of pocket (OOP) health expenditure >40% of non-food expenditure. Bi-variate analysis and binary logistic regression were used to test for association and control for confounders respectively with statistical significance determined at p Results : the average cost per TB patient successfully treated from the patient’s perspective was US$485.7 in private health facilities and US$262.9 in public health facilities (t = -2.787, p = 0.006). There was a statistically significant difference in the incidence of CHE due to TB between patients in public health facilities (21.2%) and private health facilities (13.1%) (AOR= 2.87, 95% CI = 1.224 - 6.731, p = 0.015). Conclusion : the incidence of CHE due to TB was higher in public health facilities compared to private health facilities. We recommend that efforts to reduce OOP expenditure (e.g. home management of TB) among TB patients in public health facilities in Kaduna State should be explored.