Client: Ministry of Health, Lesotho
Country: Lesotho
Period: 2018–2019
Role: Research Company (Joint Venture with Health Focus South Africa)
CESAR, in joint venture with Health Focus South Africa, conducted a nationally representative TB patient cost survey in Lesotho to estimate out-of-pocket expenditure (OOPE) and catastrophic health expenditure (CHE) among drug-sensitive and multidrug-resistant TB patients. The study formed part of the World Bank–funded Southern Africa TB and Health Systems Support (SATBHSS) Project and aimed to assess the financial burden of TB on households and its implications for treatment access and outcomes.
The study surveyed 832 TB patients across 53 health facilities in all 10 districts, using a two-stage stratified cluster sampling design and the WHO TB Patient Cost Survey tool, adapted for Lesotho.
CESAR designed the study methodology, adapted the WHO survey instrument and implemented electronic data collection nationwide. The team conducted advanced cost estimation using bottom-up expenditure analysis, separating direct medical, non-medical and indirect productivity costs. Weighted statistical analysis, multivariable regression and sensitivity analyses were performed to determine the prevalence and predictors of catastrophic expenditure. A comprehensive technical report, including policy recommendations aligned with the End TB Strategy, was delivered to the Ministry of Health.
The study provided the first nationally representative evidence on the economic burden of TB in Lesotho. It showed that while TB services are officially free, patients incur substantial non-medical and income-related costs, with catastrophic expenditure affecting a significant proportion of households, particularly those with MDR-TB and those in the poorest income groups. Studies of this nature are critical for strengthening patient-centred TB care, in particular and for informing social protection reforms, in general.
