Plenary three: social protection for a more holistic approach to ending TB

In countries around the world, the social and financial impact of disease is often overlooked in the conversation about access to services and affordable treatment. Plenary session three focused on ending tuberculosis (TB) in the era of the sustainable development goals (SDGs) and examined resistance to social protections as an integral step in making healthcare equitable and accessible to everyone.

“This session is not intended to somehow reinforce this idea that TB is only an issue of poverty. What we are talking about here is that this is an airborne disease and everyone is potentially at risk – so the way to deal with this is with a universal approach. It is up to us as the TB community to appeal to these more comprehensive methods”, said Prof Bertie Squire, who opened the session.

The plenary highlighted that although many countries have made great strides in providing TB services free of charge, countries and social schemes often do not take into account the sometimes exorbitant costs incurred in accessing care and the social implications involved in illness.

Amy McConville, a TB survivor from the UK, shared her story of six years spent battling TB – first battling to diagnose it, and then battling with her treatment and the social and financial consequences of the experience. She was forced to take out loans and use overdraft allowances on her accounts to afford her care and was eventually diagnosed with depression and anxiety during the prolonged treatment process.

“I was reluctant to tell my family and close friends that I had financial difficulties and I felt ashamed of my circumstances. I felt it was a reflection of a personal failing”, she said.

Diana Weil, Coordinator of the Policy and Strategy Unit of the Global TB Programme at WHO, put the conversation on social protection into the context of the SDGs.

“So many of the SDGs are related to relieving poverty, whether it's hunger, gender equality, peace and justice, or social protection”, she explained. “We aim to prevent TB through poverty reduction, and reduce poverty by ending TB.

“It’s not an easy topic for parliamentarians and governments to talk about – welfare and social aid – but the SDGs are giving us that push that we need to move this forward.”

Dame Margaret Whitehead, Professor of Public Health, University of Liverpool, spoke about social protection set in a wider context of the vicious cycle of poverty and disease. She said:

“In China, for low-income TB patients, spending was 112 percent of annual income on medical care. For high-income patients, spending was 32 percent. For both groups – high and low – that is exceptional, but in the case of low-income patients, it is catastrophic.”

 “If a country is currently spending very little of their GDP on social protection and they increase spending by as little by one percent, there is a decrease in prevalence, incidence and mortality.”

Dr Fabio Veras, an economist working in conditional cash transfers, shared his knowledge and experience on the most obvious entry points to make social protections available to TB patients in Brazil, where the social protections provided offer financial support to patients, not only to cover their medical expenses but to assist them with incidental costs incurred.

“TB patients that received financial assistance during treatment were seven percent more likely to be cured, compared to patients who were eligible but did not receive assistance”, he explained.

The panelists stressed the need for universal and equal access to care, not special services for those in greater need.

“Let’s enable people access to the services that they should have access to, where they don’t have to declare they are poor. NGOs can help reduce the red tape; we can help people fill out their forms or help them find out where the services are or what services exist. No one should ever have to have a conversation about their needs to get what everyone should have access to”, said Diana Weil.

The session was chaired by Dr Knut Lonnroth, University of Gothenburg, and Dr Delia Boccia, London School of Hygiene and Tropical Medicine.