Socioeconomic and health policy challenges to the availability, accessibility, and affordability of drug therapy among people living with tuberculosis towards public and private hospitals in Agra district, Uttar Pradesh, India: a cross-sectional study

Abstract

                India aims to achieve the goal of eliminating tuberculosis (TB) by the year 2025, five years ahead of the global target set for 2030. However, there are challenges in providing universal health coverage (UHC) for people living with tuberculosis (TB) due to inadequate resources and the unaffordability of medicine. This study aims to explore the socioeconomic and health policy challenges to drug therapy among people living with TB in the Agra district, Uttar Pradesh, India. A cross-sectional mixed-methods study was undertaken based on a facility-based survey and semi-structured interviews, involving 2244 participants from 20 major health facilities. The analysis focused on medical characteristics, OOPE, service utilization, and policy measures, with contributing factors and suggestions for improving service utilization and reducing OOPE on medicines. About 61% of 2244 participants were availing private healthcare services. Availability of medicines at public and private hospitals was reported by 98% and 48% of patients, respectively. Nearly 91% of private-sector patients couldn't afford the drugs. Government health policy implications for nutrition aid covered 92% of public sector patients, but only 21% of private sector patients. In both sectors, most patients spend their salaries and savings, which contributes to OOPE. Socio-economic and health policy challenges affect drug therapy availability, accessibility, and affordability. Addressing these challenges requires increased investment in infrastructure, drug supply chains, health insurance coverage, and coordination between public and private providers.