TUBERCULOSIS

Chapter 7 :: TB financing
:: KEY FACTS AND MESSAGES
The Stop TB Partnership’s Global Plan to End TB, 2016–2020 a
estimates that in low- and middle-income countries
US$ 52 billion is required over 5 years to implement
interventions that are currently available. The amount
required will increase from US$ 8.3 billion in 2016 to
US$ 12.3 billion in 2020. Most of this funding is for drugsusceptible
tuberculosis (TB) (e.g. US$ 6.4 billion in 2016),
but the amount for multidrug-resistant TB (MDR-TB) doubles
from US$ 1.7 billion in 2016 to US$ 3.6 billion by 2020; the
remainder is for TB/HIV interventions. Over the period
2016–2020, a further US$ 6 billion is needed for high-income
countries, and an additional US$ 9 billion is needed for TB
research and development.
Based on data reported to WHO by 126 countries with 97%
of the world’s notified TB cases, US$ 6.6 billion was available
for TB prevention, diagnosis and treatment in low- and
middle-income countries in 2016. This is an increase from
previous years, but is still about US$ 2 billion less than the
estimated requirement for this group of countries in the
Global Plan. Increased domestic and international donor
commitments are needed to close the funding gaps.
Of the US$ 6.6 billion available in 2016, 84% was from
domestic sources. However, this aggregate figure is
strongly influenced by the BRICS countries (Brazil, the
Russian Federation, India, China and South Africa), which
collectively account for about 50% of the world’s TB cases,
and rely mostly or exclusively (the exception is India) on
domestic funding. In other countries with a high TB burden,
international donor funding dominates, accounting for 75% of
reported funding in the group of 25 high TB burden countries
outside BRICS, 87% of funding in low-income countries and
60% of funding in lower middle-income countries. The single
largest source of international donor funding is the Global
Fund to Fight AIDS, Tuberculosis and Malaria.
International donor funding for TB falls far short of donor
contributions for HIV and malaria. The latest data from the
Organisation for Economic Co-operation and Development
(OECD) creditor reporting system show totals of
US$ 5.4 billion for HIV/AIDS, US$ 1.7 billion for malaria and
US$ 0.7 billion for TB in 2014. To provide some context for
these amounts, the latest estimates (for 2013) of the burden
of disease in terms of disability-adjusted life years (DALYs)
lost due to illness and death are 69 million for HIV/AIDS,
50 million for malaria and 65 million for TB.
The cost per patient treated is usually in the range of
US$ 100–1000 for drug-susceptible TB and US$ 2000–
20 000 for MDR-TB.
Health financing data from national health accounts provide
insights into the current status of progress towards universal
health coverage, as discussed in Chapter 6.
a
The Global Plan to End TB, 2016–2020. Geneva: Stop TB
Partnership; 2015 (http://www.stoptb.org/global/plan/, accessed
28 July 2016).
Progress in tuberculosis (TB) prevention, diagnosis and
treatment requires adequate funding sustained over many
years. WHO began annual monitoring of funding for TB
in 2002, with findings published in global TB reports and
peer-reviewed publications. 1
This chapter has four main sections. It starts with a
summary of the most up-to-date estimates of financial
resources required for a full response to the TB epidemic
2016–2020 (Section 7.1). It then presents and discusses
trends in funding for TB prevention, diagnosis and treat-
1
The most recent publication is: Floyd K, Fitzpatrick C, Pantoja A,
Raviglione M. Domestic and donor financing for tuberculosis care and
control in low-income and middle-income countries: an analysis of
trends, 2002–11, and requirements to meet 2015 targets. Lancet Glob
Health. 2013;1(2):e105–115 (http://www.ncbi.nlm.nih.gov/
pubmed/25104145, accessed 28 July 2016).
ment by category of expenditure and source of funding
for the period 2006–2016, globally and for major country
groupings (Section 7.2). The third part of the chapter analyses
funding gaps reported by national TB programmes
(NTPs) to WHO, with breakdowns by category of expenditure
and country group (Section 7.3). The final section
provides the latest estimates (for 2015) of the unit costs of
treatment for drug-susceptible TB and multidrug-resistant
TB (MDR-TB) (Section 7.4).
As highlighted in the financing chapter of the Global
tuberculosis report 2015, 2 analysis of health financing data
2
World Health Organization. Global tuberculosis report 2015. Geneva:
WHO; 2015 (http://apps.who.int/iris/
bitstream/10665/191102/1/9789241565059_eng.pdf, accessed 27
July 2016).
108 :: GLOBAL TUBERCULOSIS REPORT 2016