Lönnroth Knut, Glaziou Philippe, Weil Diana, Floyd Katherine, Uplekar Mukund, Raviglione Mario
Global TB Programme, World Health Organization, Geneva, Switzerland.
PLoS Med. 2014 Sep 22;11(9):e1001693. doi: 10.1371/journal.pmed.1001693. eCollection 2014 Sep.
Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.
结核病仍然是一个重大的全球公共卫生问题。在所有社会中，该疾病对最贫困人群的影响最为严重。世界卫生组织制定了一项2015年后的全球结核病新战略，该战略明确强调了全民健康覆盖（UHC）和社会保护的关键作用。其中一个提议的目标是“没有结核病患者家庭因结核病而承受灾难性费用”。高昂的直接和间接医疗费用阻碍了就医机会，增加了结核病治疗效果不佳的风险，加剧了贫困，并助长了结核病的传播。全民健康覆盖通常被定义为能够获得医疗保健，而不会因自付医疗费用而面临经济困难风险，这对于有效且公平的结核病防治至关重要，但并不充分。预防或减轻与结核病相关的其他经济风险的社会保护干预措施也很重要，这些风险包括收入损失以及交通和食品等非医疗支出。我们提出了一个监测健康和社会保护覆盖情况及其对结核病流行病学影响的框架。我们描述了关键指标并回顾了方法学考量。我们表明，虽然监测一般医疗保健的可及性对于跟踪结核病服务提供的卫生系统环境很重要，但关于结核病可及性、质量和经济风险保护的具体指标也可以作为对公平敏感的追踪指标，用于衡量在实现总体可及性和社会保护方面取得的进展和成果。
