Socioeconomic problems should be addressed to enable patients and their families to be able to complete TB treatment and reduce the impact that the disease and treatment have on their quality of life. These challenges can be successfully tackled through socioeconomic interventions, such as food baskets or transportation vouchers, that enable patients to complete the treatment and which usually work best when they are adapted to a patient’s specific needs. Some NTPs and health-care providers have used these as enablers – i.e. as a means to help patients to address hurdles in taking medication and completing therapy. While enablers may improve outcomes, it is most important to use material support to overcome barriers that otherwise would be impossible for patients to overcome without some form of support.
Material support can be services or commodities – e.g. financial support, food baskets, food supplements, food vouchers, transport subsidies, living allowance, housing enablers or cash transfer. This support helps patients or caregivers with the costs they face in order to obtain health services and tries to lessen the stress of income loss related to TB. At the beginning of treatment, the financial resources of the patient should be evaluated in order to support those in need of assistance using material support. The most support should be given to patients with the most need. Health-care workers, treatment supporters, social workers or other professionals can help evaluate needs and make sure the material support reaches the patient. Cash transfers and microfinance support can improve household food security, which has been shown to increase access to health care. When prolonged hospitalization is necessary, supporting the patient and their family financially with a minimum “livingallowance” would be a helpful step under the patient-centred care approach.
Nutritional support is particularly important and can be part of material support. Not only does nutritional support help to lessen the financial stress of TB disease, but malnutrition/undernutrition can make TB disease worse, and TB can cause malnutrition. People who are malnourished/undernourished and who have TB disease are more likely to have worse outcomes and are more likely to die of TB than others. Children and pregnant/lactating women are at particular risk from malnutrition. Treatment of malnutrition/undernutrition through material support should be considered just as important as other TB medications when managing patients with TB. Indeed, nutritional support should be included as part of a standard treatment and care plan for TB. Further details on nutritional care and support can be found in the Guideline: nutritional care and support for patients with tuberculosis (21) and WHO framework for collaborative action on tuberculosis and comorbidities (22).
The involvement of civil society – such as patient support groups and nongovernmental organizations, as well as community- or faith-based organizations – is necessary to provide social support services. A more long-term way to provide material support to TB patients is to include all patients who qualify in the social protection programmes (such as unemployment benefits if the patient cannot work) that many countries have for vulnerable populations.