Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study

Published April 23, 2020, in The Lancet Infectious Diseases (opens in a new window)


Estimates of government spending and development assistance for tuberculosis exist, but less is known about out-of-pocket and prepaid private spending. We aimed to provide comprehensive estimates of total spending on tuberculosis in low-income and middle-income countries for 2000–2017.


We extracted data on tuberculosis spending, unit costs, and health-care use from the WHO global tuberculosis database, Global Fund proposals and reports, National Health Accounts, the WHO-Choosing Interventions that are Cost-Effective project database, and the Institute for Health Metrics and Evaluation Development Assistance for Health Database. We extracted data from at least one of these sources for all 135 low-income and middle-income countries using the World Bank 2019 definitions. We estimated tuberculosis spending by source and function for notified (officially reported) and non-notified tuberculosis cases separately and combined, using spatiotemporal Gaussian process regression to fill in for missing data and estimate uncertainty. We aggregated estimates of government, out-of-pocket, prepaid private, and development assistance spending on tuberculosis to estimate total spending in 2019 US dollars.


Total spending on tuberculosis in 135 low-income and middle-income countries increased annually by 3.9% (95% CI 3.0 to 4.6), from $5.7 billion (5.2 to 6.5) in 2000 to $10.9 billion (10.3 to 11.8) in 2017. Government spending increased annually by 5.1% (4.4 to 5.7) between 2000 and 2017, and reached $6.9 billion (6.5 to 7.5) or 63.5% (59.2 to 66.8) of all tuberculosis spending in 2017. Of government spending, $5.8 billion (5.6 to 6.1) was spent on notified cases. Out-of-pocket spending decreased annually by 0.8% (−2.9 to 1.3), from $2.4 billion (1.9 to 3.1) in 2000 to $2.1 billion (1.6 to 2.7) in 2017. Development assistance for country-specific spending on tuberculosis increased from $54.6 million in 2000 to $1.1 billion in 2017. Administrative costs and development assistance for global projects related to tuberculosis care increased from $85.3 million in 2000 to $576.2 million in 2017. 30 high tuberculosis burden countries of low and middle income accounted for 73.7% (71.8–75.8) of tuberculosis spending in 2017.


Despite substantial increases since 2000, funding for tuberculosis is still far short of global financing targets and out-of-pocket spending remains high in resource-constrained countries, posing a barrier to patients' access to care and treatment adherence. Of the 30 countries with a high burden of tuberculosis, just over half were primarily funded by government, while others, especially lower-middle-income and low-income countries, were still primarily dependent on development assistance for tuberculosis or out-of-pocket health spending.

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Su Y, Baena IG, Harle AC, Crosby SW, Micah AE, Siroka A, Sahu M, Tsakalos G, Murray CJL, Floyd K, Dieleman JL. Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study. The Lancet Infectious Diseases. 23 April 2020. doi:10.1016/S1473-3099(20)30124-9.


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