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Table 2 Summary of suggestions and research priorities for the operational challenges discussed

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

Operational challenges

Interim solutions

Research priorities

Implementation strategy

1. Preliminary programmatic assessment of the TB-epidemiology profile and existing social protection environment based on structured framework including the following:

• What population group is most affected by TB?

• What are the barriers that prevent people from accessing the TB care services and completing treatment?

• What are the socioeconomic consequences of TB and TB care on TB affected households?

• What social protection schemes are in place? What population group they target? What geographic areas they cover and how they overlap with TB distribution? What is the proportion of TB affected-individuals/households reached by these schemes based on their enrolment criteria? How these schemes could be made more inclusive for TB-patients?

2. Ideally start with interim, relatively small, TB-specific interventions, aimed to address a specific TB control indicator to generate impact evidence and operational lessons.

1. To design a programmatic assessment tool to support countries in choosing the best implementation strategy based on the TB epidemic profile and social protection features.

2. To undertake an inventory of all existing social protection initiatives somehow linked or linkable to TB control run at governmental and non-governmental level, then to identify the most promising initiatives to undergo impact and operational evaluation.

3. To create a network of impact and process evaluations from different countries so to have an overview of what works, where and why and share methodological and programmatic lessons. This could require approach, prioritising first TB-specific initiatives and natural experiments or quasi-experimental methods.

4. To develop and apply metrics to measure economic impact of TB for households

5. To develop innovative and rapid impact evaluation techniques, including mathematical modelling.

Conditional vs Unconditional

1. Undertake qualitative studies among intervention recipients to access the appropriateness of the conditions proposed and potential barriers to compliance.

2. If strict conditionality is deemed unfeasible or counterproductive, attempt the use of “soft” forms of conditionality.

• Do not reduce the transfer size or decline eligibility only after several months of non-compliance with the behavioural requirements.

• Do apply conditionality only for behaviour requirements that are simple to meet (i.e. attending TB education workshops).

1. Identify key TB-control related behaviours that are more likely to be affected by the use of conditionalities.

2. Explore if and how conditionality compliance is influenced by the size of cash transfer, the frequency of cash transfers, other psychosocial and behavioural determinants, TB status and stage of disease.

3. Identify strategies to effectively and cost-effectively monitoring these conditionalities.

Targeting approach

They are likely to differ depending on settings. Use multiple criteria based on poverty criteria and a risk score for TB.

1. Verify targeting accuracy through qualitative assessment and TB surveys among the cash recipients;

2. Assess the effectiveness and cost-effectiveness of different targeting strategies;

Sustainability

Identify multiple donors, domestic and international, addressing specific costs of the intervention.

1. Extended cost-effective analysis (ECEA) to evaluate costs against TB costs mitigation at household, community and country level

2. Explore co-financing mechanisms