The cost of tuberculosis to patients in Sierra Leone's war zone.

Objective: To evaluate how the extreme poverty of the patients and the poor salaries of the staff combined to increase the cost of treatment to patients within the subsidised national tuberculosis programme in Sierra Leone.

Design/setting: From September to December of 1994, semi-structured interviews were conducted with 72 patients and 17 staff of the National Leprosy and Tuberculosis Control Programme of Sierra Leone, a screening and treatment programme funded by international donors.

Results: Although some extra costs were indeed incurred within the subsidized national tuberculosis treatment programme, they were much lower than those incurred during the pre-programme period when the patients sought intermittent help from a wide range of traditional and biomedical sources within the plural healing continuum. The national politico-economic crisis, and the consequent poverty of most patients, impeded compliance with and sustainability of treatment, even within the formal subsidised treatment programme.

Conclusions: More money was spent by patients on treatment in the months/years preceding entry into the national tuberculosis programme. Many factors retarded entry, including poor communications, misinformation, malpractice by health professionals, and displacement resulting from chronic internal warfare. The war intensified all factors that predispose to tuberculosis and retarded access to treatment. Supra-programme cost, or 'corruption,' was minimal due to the poverty of health professionals, with a few salient exceptions.