{"id":649,"date":"2025-09-12T15:28:17","date_gmt":"2025-09-12T15:28:17","guid":{"rendered":"https:\/\/blogs.isb.edu\/healthcare\/?p=649"},"modified":"2025-12-31T09:23:53","modified_gmt":"2025-12-31T09:23:53","slug":"the-hidden-cost-of-tb-in-india-what-education-and-poverty-have-to-do-with-it","status":"publish","type":"post","link":"https:\/\/blogs.isb.edu\/healthcare\/2025\/09\/12\/the-hidden-cost-of-tb-in-india-what-education-and-poverty-have-to-do-with-it\/","title":{"rendered":"The Hidden Cost of TB in India: What Education and Poverty Have to Do With It"},"content":{"rendered":"\n

India has the highest TB burden in the world, accounting for nearly 27% of global cases. In 2022, out of the estimated 10.6 million TB cases worldwide, 2.8 million occurred in India. One of the targets for TB in the Sustainable Development Goals (SDGs) is that \u201czero TB patients and their households face catastrophic costs as a result of TB disease.\u201d According to the WHO framework, catastrophic cost is defined as the total cost (direct + indirect cost) exceeding 20% of household yearly income [1]. Direct costs include medical expenses, such as diagnosis, doctor fees, and non-TB drugs, as well as non-medical expenses, including travel, accommodation, and food. Indirect costs refer to time lost due to illness, which can lead to employment disruption or job loss.<\/p>\n\n\n\n

A recent study conducted across four Indian states\u2014Assam, Maharashtra, Tamil Nadu, and West Bengal\u2014found that 30\u201361% of households affected by TB face catastrophic costs [2]. The worrying aspect is that half of these households fall into financial ruin even before treatment begins, largely due to heavy borrowing. This indicates that a significant share of catastrophic costs arises during the pre-treatment phase, further contributing to delays in the initiation of actual treatment.<\/p>\n\n\n\n

The Government of India, under the National TB Elimination Program (NTEP), provides free diagnosis, free medication, and INR 500 per month during the six months of treatment to all TB patients in the country [1]. Despite these provisions, a significant number of households with TB patients still incur catastrophic costs. India\u2019s low public health spending pushes many patients toward private facilities where care is costlier. Because treatment costs are similar across income groups, poorer households bear a far heavier burden. Limited awareness and education compound the problem, driving many to self-medication or informal providers, which delays diagnosis and adds avoidable expenses before proper treatment begins.<\/p>\n\n\n\n

Let us explore the roles of education and poverty as driving socio-demographic and economic factors behind these costs.<\/p>\n\n\n\n

Education & Early diagnosis: <\/strong>A study conducted in the South 24 Parganas district of West Bengal indicated that more than 95% of TB patients were from lower socio-economic classes and had poor literacy levels.[4] Education is directly linked to income. A person with low literacy often fails to understand the importance of early testing. Instead of consulting at a public or private facility, they begin self-treatment by taking medication from a pharmacy or informal healthcare providers. This leads to delays in proper treatment and results in additional expenses on travel, unnecessary diagnostic tests, and non-TB medicines\u2014ultimately causing financial loss, delayed diagnosis, and treatment delays.<\/p>\n\n\n\n

Poverty, Unemployment & Income Loss: <\/strong>A significant share of TB patients in India come from poor socio-economic backgrounds, most of whom depend on daily wages. A study found that the proportion of households affected by TB facing catastrophic costs was the highest\u2014around 60% using the Output Approach (OA)\u2014indicating a high level of unemployment and consequent income loss [3].
In OA, the indirect cost is calculated as the difference between self-reported household income before TB and during TB treatment. While this approach captures reduced productivity in the form of income loss, it fails to account for the indirect costs of time spent by patients and caregivers not engaged in paid work (such as housewives and students).<\/p>\n\n\n\n

Let us understand this with two examples,
Consider two TB patients: Patient A, a daily-wage worker, and Patient B, a salaried employee. Patient A\u2019s household income is INR 300 per day (\u2248 INR 108,000 per year), while Patient B\u2019s household income is INR 1,000 per day (\u2248 INR 360,000 per year).<\/p>\n\n\n\n

Absolute Loss<\/strong><\/p>\n\n\n\n

Suppose both households incur an equal loss of INR 12,000 due to TB illness (direct + indirect cost):<\/p>\n\n\n\n