Who benefits from tuberculosis outpatient services in Enugu state, Nigeria? A benefit incidence analysis

Objectives Nigeria is one of the 30 high-burden countries for TB and currently, recurrent costs of TB treatment services are largely dependent on donor-funding, with government providing the health facilities. This study aims to assess the benefit incidence of TB treatment services so as to determine if the poor and rural dwellers preferentially benefit from such services that were subsidized by government and donors. Methods A survey of patients (n = 202) accessing TB treatment services was conducted between 2019 and 2020 in five purposively selected rural and urban health facilities in Enugu state. Socio-economic status (SES) was estimated using household assets ownership. Benefits of TB services were measured by multiplying the unit cost of utilization of different services while the net benefit was calculated by subtracting out-of-pocket (OOP) payments incurred from the benefits. We estimated the benefit for 1 month and the benefit for the whole TB treatment course (6 months). Concentration index was used to determine the level of equity in spending across the socio-economic quintiles. Results 56.4% of the respondents were from urban facilities. 100% had used TB drugs in the past months, 73% had undergone a Gene-Xpert test, and 67% had had a consultation. All patients received TB drugs without OOP payment, but 90% paid for X-ray. Urban respondents captured a disproportionally higher share of benefit from TB services. The concentration index was -0.025 for net benefit from TB services across different quintiles, indicating the pro-poor distribution of TB services in Nigeria. Conclusions The benefit from TB services had a pro-poor distribution, but urban respondents obtained a disproportionally higher share of gross and net benefit from TB services. Funding for TB services needs to be secured to promote the equitable access to TB services.