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Table 1 Implementation strategies: working definitions for TB

From: Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities

 

Definition

Examples

Advantages

Disadvantages

TB-specific initiatives

Cash transfer interventions explicitly targeting TB-affected individuals and/or households with the intent of addressing a specific TB care and prevention issue [35].

ISIAT [28] and CRESIPT Project in Peru [46]

Voucher intervention in South Africa [43, 44]

They may represent the only option in contexts where existing social protection schemes have limited resources hampering the further expansion of their scope (i.e. the inclusion of TB control objectives)

They may be more suitable in contexts where specific vulnerable groups are involved and/or treatment adherence support or costs mitigations interventions are to be prioritised

TB control programs staff may not have the competence and resources to manage these extra activities

They may be perceived as stigmatising

TB-inclusive initiatives

Cash transfer schemes that are not limited to TB-related issues but include TB disease amongst their eligibility criteria.

Temporary Disability Grant in South Africa addressing people temporarily unable to work, including people living with TB disease and MDR-TB cases in particular

Same as the TB-specific initiatives

They may represent a good compromise between TB-sensitive and TB specific to minimise the respective disadvantages

The may be still perceived as stigmatising. Further the impact of the intervention may be diluted across other health outcomes

TB-sensitive initiatives

Cash transfers interventions not specific to TB patients but that could have an impact for TB patients or for TB prevention because they target groups and/or people at high risk of TB and vulnerable to deeper impoverishment due to its consequences [35].

Bolsa Familia conditional cash transfer scheme in Brazil that may occasionally enrol TB patients not because of their health status, but because they meet the enrolment poverty profile applied by the programme [41]

They may represent the most efficient way to optimise existing resources

They may be the best choice in contexts where TB incidence is not going down despite the good performance of the local TB control programmes in terms of percentage of case finding and treatment success rates

They reduce the risk of stigmatisation of TB-patients

Making them more inclusive for people at risk of TB may interfere with their performance and affect their budget, especially in countries where these schemes are already run with limited resources

Government-run schemes may be reluctant to address public health problems as their main objective remain fundamentally to address poverty

Government-run schemes may be reluctant to address TB over other public health priorities