SPARKS Network – Health and Social Protection Action Research & Knowledge Sharing

Selected List of Publications from SPARKS Network Members:

1. Social policy in Brazil (2004–2014): an overview – Social policy has played a central role in developing countries over the last decade, contributing to a significant decline in poverty and inequality. The objective of this paper is to provide an overview of the evolution of social policy in Brazil, its effects on inequality and poverty, and the implications of the current political and economic scenario regarding the maintenance of its continuous progress. (Patrícia Andrade de Oliveira e Silva, International Policy Centre for Inclusive Growth 2017)
2. Catastrophic health costs averted by TB control: findings for India and South Africa from a modeling study: The economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO’s End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs. (Stéphane Verguet, The Lancet 2017)
3. Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis; or to increase income of households with high TB risk to strengthen their economic resilience. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. (William E. Rudgard, PLOS Medicine 2017)
4. Modelling the social and structural determinants of TB: opportunities and challenges: Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants. We reviewed studies employing mathematical modelling to evaluate the epidemiological impact of the structural determinants of TB. (Debora Pedrazzoli, The International Journal of Tuberculosis and Lung Diseases 2017)
5. Uptake of governmental social protection and financial hardship amongst drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil:In May 2016, there were 1601 people with drug-resistant TB in Brazil, with 29% residing in Rio de Janeiro state. To evaluate whether uptake of social protection during treatment is associated with reduced risk of experiencing financial hardship,  a cross-sectional survey of people with drug-resistant TB who had been receiving treatment for at least 1 month and were attending an outpatient clinic in Rio de Janeiro state was conducted. The uptake of social protection was associated with lower risk of incurring total costs ≥20% of household income, impoverishment and experiencing all three hardships, but not with using a coping strategy. (William E. Rudgard, European Respiratory Journal 2018)
6. Addressing social determinants to end tuberculosis: Leave no one behind. This is the overarching pledge of the Sustainable Development Goals; a pledge that is far from being realised. In 2016, more than 4 million people with tuberculosis were estimated to be undiagnosed or their care and treatment were unknown. In the same year, nearly a fifth of the people who were diagnosed and known to be treated for tuberculosis had adverse outcomes, including 1·3 million deaths. One reason that millions of people affected by tuberculosis are left behind is an absence of coordinated, international action to combat poverty and inequality. (Tom Wingfield, The Lancet 2018)
7. The impact of social protection and poverty elimination on the End TB strategy targets: a statistical model of Sustainable Development Goal: The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculosis incidence that could be obtained by reaching SDG 1. (Daniel Carter, The Lancet 2018)
8. Modelling the impact of social protection on tuberculosis: the S-PROTECT project  – Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. However, evidence informing policies are still scarce. Mathematical modelling has the potential to contribute to fill this knowledge gap, but existing models are inadequate. The S-PROTECT consortium aimed to develop an innovative mathematical modelling approach to better understand the role of social protection to improve TB care, prevention and control. (Delia Boccia, BMC Public Health 2018)
9. How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana – Tuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi-drug resistance (MDR). The End TB Strategy calls for zero TB-affected families incurring ‘catastrophic’ costs due to TB by 2025. This paper examines, by MDR status, the level and composition of costs incurred by TB-affected households during care seeking and treatment; assesses the affordability of TB care using catastrophic and impoverishment measures; and describes coping strategies used by TB-affected households to pay for TB care. (Debora Pedrazzoli, Tropical Medicine and international health 2018)
10. Measuring catastrophic costs due to tuberculosis in Viet Nam: Progress towards ending tuberculosis (TB) in Viet Nam includes monitoring the costs borne by patients through periodic facility-based surveys.The proportion of households experiencing catastrophic total costs due to TB in Viet Nam is high, which poses a barrier to TB diagnosis and treatment. Based on study results, programme and partners need to identify key areas for policy action and work towards a national policy guide on intervention to reduce TB patient costs. (N.V. Nhung, The International Journal of Tuberculosis and Lung Disease 2018)
11. Measuring the economic burden for TB patients in the End TB Strategy and Universal Health Coverage frameworks: The End TB Strategy promotes both patient-centred TB services and social protection measures, which aim to mitigate the economic hardship faced by TB patients and their households due to direct medical and non-medical expenditures, as well as to lost income. The strategy includes a target that no families should face catastrophic total costs due to TB. The indicator linked to this target aims to capture the total economic burden linked to TB care, and thus differs from the ‘catastrophic expenditure on health’ indicator, a key component of the UHC monitoring framework aligned with the Sustainable Development Goals. Countries, and particularly high TB burden countries, are expected to conduct nationally representative TB patient cost surveys to establish baseline measurements for the catastrophic costs indicator. Findings from these surveys should also help identify entry points for developing policies to ensure better financial and social protection for TB patients. In this paper, we define the key measurable concepts for TB patient cost surveys, notably the types of costs that are captured, and related affordability measures. We discuss methods for measuring these notions in the UHC framework and contrast them with how they are measured in TB patient cost surveys. (Debora Pedrazzoli, The International Journal of Tuberculosis and Lung Disease 2019)
    
12. The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region: The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020. (Kerri Viney, Tropical Medicine and Infectious Disease 2019)

Other Publications:

1. Cash interventions to improve clinical outcomes for pulmonary tuberculosis: systematic review and meta-analysis
   This study aimed to assess cash transfer interventions for improving treatment outcomes of active pulmonary tuberculosis in low- and middle-income countries.
2. Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis
   The aim of this systematic review was to identify and assess evidences of social protection effects on TB treatment outcomes in low- and middle-income countries or in high TB-burden countries.
3. Evaluation of a social protection policy on tuberculosis treatment outcomes: A prospective cohort study
   This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients.
4. Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review
   The systematic review aimed to explore interventions to reduce global loss to follow-up (LTFU) during drug-resistant tuberculosis (DR-TB) treatment.
5. Active Case Finding Among Marginalised and Vulnerable Populations Reduces Catastrophic Costs Due to Tuberculosis Diagnosis
   This study aimed to determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding.

6. Active Versus Passive Case Finding for Tuberculosis in Marginalised and Vulnerable Populations in India: Comparison of Treatment Outcomes
   This study aimed to determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people.

7. A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study
   This study measured service coverage by a weighted geometric average of four prevention indicators (antenatal care, full immunisation, and screening for breast and cervical cancers) and four treatment indicators (skilled birth attendance, inpatient admission, and treatment for acute respiratory infection and diarrhoea), financial protection by the incidence of catastrophic health expenditures (those exceeding 10% of household consumption or income), and a country’s UHC performance as a geometric average of the service coverage index and the complement of the incidence of catastrophic expenditures.