Consolidated guidance on tuberculosis data generation and use: module 4: surveys of costs faced by households affected by tuberculosis

Tuberculosis imposes a substantial economic burden on affected individuals and households, often leading to catastrophic costs that hinder access to care and successful treatment outcomes. This document presents updated WHO guidance within the consolidated framework on tuberculosis data generation and use, providing a standardized methodology for conducting surveys of costs faced by households affected by tuberculosis to support monitoring and policy development.

It outlines the rationale, objectives and design of facility-based cross-sectional surveys to measure direct medical, direct non-medical and indirect costs, and to estimate the proportion of households experiencing catastrophic total costs, a key indicator of the End TB Strategy. The guidance describes all stages of survey implementation, including situation assessment, sampling, data collection, analysis and dissemination, alongside ethical considerations and operational planning. It also captures coping strategies, social consequences and the use of social protection measures, and incorporates methodological updates based on country experience. While acknowledging limitations inherent to the cross-sectional design and potential recall bias, it emphasizes the use of findings to inform policy dialogue. Intended for national tuberculosis programmes, policy-makers and technical partners, it supports the generation of robust, comparable data to guide interventions that reduce financial barriers, strengthen social protection and improve equitable access to care.